Coincidence of idiopathic ventricular outflow tract tachycardia and atrioventricular nodal reentrant tachycardia.

Abstract

Tachycardia-induced tachycardia appears to be a relatively rare condition. In such cases an important question arises whether catheter ablation of one arrhythmia may prevent the occurrence of another. This paper reviews single-centre experience with coincident idiopathic outflow tract ventricular tachycardia (VT) and atrioventricular (AV) nodal reentry tachycardia (AVNRT), and strategy of treatment. Seven of 46 patients (15%) with clinically documented idiopathic outflow tract VT were found to have reproducibly inducible AVNRT at the time of an electrophysiological study. There were two men and five women (mean age 35+/-9 years, range 20-44) without structural heart disease. During the study, AVNRT spontaneously triggered VT in three cases. Radiofrequency catheter ablation of the slow pathway did not suppress subsequent inducibility of VT in any of them. Successful catheter ablation of VT did not prevent clinical recurrence of AVNRT in one patient, and led to transition of VT into typical AVNRT in another. Coincidence of idiopathic outflow tract VT and AVNRT was found in 15% of cases of clinically documented idiopathic VT. Catheter ablation of one arrhythmia substrate did not prevent inducibility or clinical recurrence of the other. These data support the strategy of performing catheter ablation of both arrhythmia substrates during one session.