Abstract
A 75-year old man with long-term arterial hypertension was diagnosed in 1998 with stage 3 chronic kidney disease due to hypertensive nephropathy. Since May 2004 the patient has been treated with intermittent hemodialysis. Since 1998 he has been hospitalized several times because of palpitations in the course of paroxysmal tachycardia with narrow QRS complexes. Initially, class I antiarrhythmic agents were administered; afterwards therapy with beta-adrenolytics was introduced. Because of the ineffectiveness of monotherapy, beta-adrenolytic therapy was combined with amiodarone; however, side effects of this treatment in a form of drug-induced bradycardia appeared. During an invasive electrophysiological investigation, a typical recurrent atrioventricular nodal reentrant tachycardia (AVNRT) was repeatedly released. Subsequently performed percutaneous ablation resulted in effective modification of the slow pathway. During 25 months of follow up after the procedure, recurrence of AVNRT was not observed. Effectiveness of ablation and low risk of adverse effects in non-dialyzed patients encourage us to recommend this method of AVNRT treatment also in patients undergoing intermittent hemodialysis.
Similar content being viewed by others
Abbreviations
- AV:
-
Atrioventricular
- AVNRT:
-
Recurrent atrioventricular nodal reentrant tachycardia
- ECG:
-
Electrocardiographic record
- EPS:
-
Invasive electrophysiological investigation
- HR:
-
Heart rate
- IHD:
-
Intermittent hemodialysis
- TTE:
-
Transthoracic echocardiography
References
Koźluk E, Walczak F, Szufladowicz E et al (1997) Types of a–v node curve: characteristic in patients with atrio-nodal reentrant tachycardia. In: Oto A (ed) “EuroPacé97” Monduzzi Editore, International proceedings division, pp 293–297
Li YG, Bender B, Bogun F et al (2000) Location of the lower turnaround point in typical AV nodal reentrant tachycardia: a quantitative model. J Cardiovasc Electrophysiol 11:34–40
McGuire M, Janse M, Ross D (1993) “AV nodal” reentry: Part II: AV nodal, AV junctional, or atrionodal reentry? J Cardiovasc Electrophysiol 4:573–586
Inoue S, Becker AE (1998) Posterior extensions of the human compact atrioventricular node: a neglected anatomic feature of potential clinical significance. Circulation 97:188–193
Kozłowski D (1999) Morfologia łącza przedsionkowo – komorowego w aspekcie powstawania zaburzeń przewodzenia i krążącego pobudzenia. Dissertation, Medical University of Gdańsk
Kozłowski D, Koźluk E, Adamowicz M et al (1998) Histological examination of the topography of the atrioventricular node artery within the triangle of Koch. PACE 21:163–167
Koźluk E, Lodziński P, Kiliszek M et al (2003) Nawrotny częstoskurcz węzłowy – czyli krótka rozprawa o zapętleniu się węzła przedsionkowo – komorowego. Kardiol po Dypl 2:68–72
Medkour D, Becker AE, Khalife K et al (1998) Anatomic and functional characteristics of a slow posterior AV nodal pathway: role in dual-pathway physiology and reentry. Circulation 98:164–174
Deetjen A, Heidland A, Pangerl A et al (1995) Antihypertensive treatment with a vasodilating beta-blocker, carvedilol, in chronic hemodialysis patients. Clin Nephrol 43:47–52
Masumura H, Miki S, Kaifu Y et al (1992) Pharmacokinetics and efficacy of carvedilol in hypertensive patients with chronic renal failure and hemodialysis patients. J Cardiovasc Pharmacol 19(suppl 1):102–107
Miki S, Masumura H, Kaifu Y et al (1991) Pharmacokinetics and efficacy of carvedilol in chronic hemodialysis patients with hypertension. J Cardiovasc Pharmacol 18(suppl 4):62–68
Kozłowski D, Koźluk E, Derejko P et al (2003) Conduction heterogeneity resulting in nonuniformity of atrioventricular nodal reentrant tachycardia—review on the base of a case report (Polish). Pol Przegl Kardiol 5:357–365
McGuire M, Bourke J, Robotin M et al (1993) High resolution mapping of Koch`s triangle using sixty electrodes in humans with atrioventricular junctional (AV nodal) reentrant tachycardia. Circulation 88:2315–2328
Obergassel L, Weismuller P, Kattenbeck K et al (1999) Typical AV nodal reentry tachycardia in 4 anterograde AV nodal pathways. Successful high frequency ablation of slow AV nodal pathways. Med Klin 94:386–390
Sorbera C, Cohen M, Woolf P et al (2000) Atrioventricular nodal reentry tachycardia. Slow pathway ablation using the transseptal approach. PACE 23:1343–1349
Trusz-Gluza M (2005)Ablacja przezskórna. In: Szczeklik A (ed) Choroby Wewnętrzne, 1st edn. Kraków, Medycyna Praktyczna, pp 222–223
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ratajewska, A.M., Banachowicz, W.W. & Grzegorzewska, A.E. Recurrent atrioventricular nodal re-entrant tachycardia treated with percutaneous ablation in a 75-year old patient undergoing intermittent hemodialysis. Int Urol Nephrol 41, 225–230 (2009). https://doi.org/10.1007/s11255-007-9302-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11255-007-9302-y