The Permanent Form of Junctional Reciprocating Tachycardia

  • Giuseppe Critelli
  • John J. Gallagher
  • Gaetano Thiene
  • Lino Rossi


In 1967, Coumel et al. [1] described a fascinating tachycardia with a normal QRS occurring predominantly in infants and children. Due to the incessant nature of this tachycardia the arrhythmia was named “permanent junctional reciprocating tachycardia” (PJRT). Although the clinical characteristics and electrocardiographic findings of PJRT have been confirmed following the original reports of the French authors, controversy has persisted for many years concerning the pathophysiologic substrate of this arrhythmia [2–9]. Recent data strongly suggest that PJRT represents a “variant” form of the preexcitation syndromes [10–17].


Coronary Sinus Accessory Pathway Carotid Sinus Massage Retrograde Conduction Bundle Electrogram 
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  1. 1.
    Coumel P, Cabrol C, Fabiato A, Gourgon R, Salma R: Tachycardie permanente par rythme reciproque. Arch. Mal Coeur 60: 1830, 1967.Google Scholar
  2. 2.
    Strasberg B, Swiryn S, Bauernfeind R, Palileo E, Scagliott D, Duffy CE, Rosen KM: Retrograde dual atrioventricular nodal pathways. Am. J. Cardiol. 48: 639, 1981.PubMedCrossRefGoogle Scholar
  3. 3.
    Gallagher JJ, Smith WM, Kerr CR, German LD, Sterba R, Sealy WC: Etiology of long RP tachycardia in 33 cases of supravenricular tachycardia. (Abstract.) Circulation 64: IV - 145, 1981.CrossRefGoogle Scholar
  4. 4.
    Wu D, Denes P, Amat-y-Leon F, Wyndam CRC, Dhingra R, Rosen KM: An unusual variety of atrioventricular nodal reentry due to retrograde dual atrioventricular nodal pathways. Circulation 56: 50, 1977.PubMedGoogle Scholar
  5. 5.
    Gallagher JJ, Sealy WC: The permanent form of junctional reciprocating tachycardia. Further elucidation of the underlying mechanism. Eur. J. Cardiol. 8: 413, 1978.PubMedGoogle Scholar
  6. 6.
    Gallagher JJ, Sealy WC, Kasell J, Klein GJ, Pritchett ELC, Davis D: The permanent form of junctional reciprocating tachycardia: evidence for an accessory ventriculoatrial pathway as the underlying substrate. PACE 2: A21, 1979.CrossRefGoogle Scholar
  7. 7.
    Epstein ML, Stone FM, Benditt DG: Incessant atrial tachycardia in childhood: association with rate-dependent conduction in accessory atrio-ventricular pathway. Am. J. Cardiol. 44: 498, 1979.PubMedCrossRefGoogle Scholar
  8. 8.
    Brugada P, Vanagt EJ, Bar FW, Wellens HJJ: Incessant reciprocating atrioventricular tachycardia. Factors playing a role in the mechanism of the arrhythmia. PACE 3: 670, 1980.PubMedCrossRefGoogle Scholar
  9. 9.
    Brugada P, Bar FW, Vanagt EJ, Friedman PL, Wellens HJJ: Observations on patients showing AV junctional echoes with a shorter P-R than R-P interval. Distinction between intranodal reentry or reentry using an accessory pathway with a long conduction time. Am. J. Cardiol. 48: 611, 1981.PubMedCrossRefGoogle Scholar
  10. 10.
    Gallagher JJ, German LD, Broughton A, Guarnieri T, Trantham JL: Variants of the preexcitation syndromes. In: Rosenbaum MB, Elizari MV Frontiers of Cardiac Electrophysiology. (eds.) The Hague: Martinus Nijhoff Publishers 724772, 1983.Google Scholar
  11. 11.
    Critelli G, Perticone F, Coltorti F, Monda V, Gallagher JJ: Antegrade slow bypass conduction after closed-chest ablation of the His bundle in permanent junctional reciprocating tachycardia. Circulation 67: 687, 1983.PubMedCrossRefGoogle Scholar
  12. 12.
    Critelli G, Gallagher JJ, Monda V, Coltorti F, Scherillo M, Rossi L: Anatomic and electrophysiologic substrate of the permanent form of junctional reciprocating tachycardia. J. Am. Coll. Cardiol. 4: 601, 1984.PubMedCrossRefGoogle Scholar
  13. 13.
    Critelli G, Gallagher JJ, Thiene G, Perticone F, Monda V, Rossi L: Histological observations after closed-chest ablation of the atrioventricular conduction system. JAMA 252: 2604, 1984.PubMedCrossRefGoogle Scholar
  14. 14.
    Critelli G, Gallagher JJ, Thiene G, Perticone F, Coltorti F, Rossi L: Electrophysiologic and histopathologic correlations in a case of permanent form of reciprocating tachycardia. Eur. Heart J. 6, 130, 1985PubMedGoogle Scholar
  15. 15.
    Gallagher JJ: Variants of preexcitation — update 1984. In: Cardiac Electrophysiology and Arrhythmias. Eds. Zipes DP and Jalife J. Grune and Stratton, New York, 1985, pp. 419–433.Google Scholar
  16. 16.
    Guarnieri T, Sealy WC, German LD: Utilization of an accessory pathway as the anterograde limb during the permanent form of junctional reciprocating tachycardia. Am. J. Cardiol. 53: 365, 1984.PubMedCrossRefGoogle Scholar
  17. 17.
    Guarnieri T, Sealy WC, Kasell JH: The nonpharmacologic management of the permanent form of junctional reciprocating tachycardia. Circulation 69: 269 1984.PubMedCrossRefGoogle Scholar
  18. 18.
    Lucet V, Do-Ngoc D, Tounmieux MC, Fidelle J, Coumel Ph: Permanent junctional reentrant tachycardia in children: long-term follow-up and treatment. In “Recent Advances in Cardiac Arrhythmias.” S Levy, R Gerard (eds.) John Libbey, London, 1983, p. 278.Google Scholar
  19. 19.
    Smith RT, Gillette PC, Garson A, Massumi A, McVey P: Evidence that some “AV node reentry” involves two anatomically separated pathways. (Abstract.) J. Am. Coll. Cardiol. 3: 483, 1984.CrossRefGoogle Scholar
  20. 20.
    Coumel P, Fidelle J, Cloup M, Toumieux ML, Attuel P: Les tachycardies reciproques a evolution prolongee chez l’enfant. Arch. Mal Coeur 67: 23, 1974.PubMedGoogle Scholar
  21. 21.
    Krikler DM, Curry P, Attuel P, Coumel P: “Incessant” tachycardias in Wolff-ParkinsonWhite syndrome. I: Initiation without antecedent extrastimulus or PR lengthening, with reference to reciprocation after shortening of cycle length. Br. Heart J. 38: 885, 1976.PubMedCrossRefGoogle Scholar
  22. 22.
    Coumel P, Attuel P, Slama R, Curry P, Krikler DM: “Incessant” tachycardias in WolffParkinson-White syndrome II: Role of atypical cycle length dependence and nodal–His escape beats in initiation of reciprocating tachycardias. Br. Heart J. 38: 897, 1976PubMedCrossRefGoogle Scholar
  23. 23.
    Coumel P, Attuel P, Motte G, Slama R, Bouvrain Y: Les tachycardies jonctionelles paroxystiques. Evaluation du point de jonction inferieur du circuit de reentree. Demembrement des “rythmes” reciproques intra-nodaux. Arch. Mal Coeur 68: 1255, 1975.PubMedGoogle Scholar
  24. 24.
    Sellers TD, Gallagher JJ, Cope GD, Tonkin AM, Wallace AG: Retrograde atrial preexcitation following premature ventricular beats during reciprocating tachycardia. Eur. J. Cardiol. 4: 283, 1976.PubMedGoogle Scholar
  25. 25.
    Gallagher JJ, Pritchett ELC, Benditt DA, Tonkin AM, Campbell RWF, Dugan FA, Bashore TM, Tower A, Wallace AG: New catheter techniques for analysis of the sequence of retrograde atrial activation. Eur. J. Cardiol. 6: 1, 1977.PubMedGoogle Scholar
  26. 26.
    Svenson RH, Miller RH, Gallagher JJ, Wallace WG: Electrophysiologic evaluation of the WolffParkinson-White syndrome. Problems in assessing anterograde and retrograde conduction over the accessory pathway. Circulation 52: 552, 1975.PubMedGoogle Scholar
  27. 27.
    Wellens HJJ, Durrer D: Patterns of ventriculoatrial conduction in the Wolff-Parkinson-White syndrome. Circulation 49: 22, 1974.PubMedGoogle Scholar
  28. 28.
    Janse MJ, Van Capelle FJL, Anderson RH, Touboul P, Billette J: Electrophysiology and structure of the atrioventricular node of the isolated rabbit heart. In The Conduction System of the Heart, MJJ Wellens, KI Lie, and MJ Janse (eds.) Lea and Febiger, Philadelphia, 1976, pp. 296–315.Google Scholar
  29. 29.
    Gallagher JJ, Svenson RH, Kasell J, German LD, Bardy GH, Broughton A, Critelli G: Catheter technique for closed-chest ablation of the atrioventricular conduction system: a therapeutic alternative for the treatment of refractory supraventricular tachycardia. N. Engl. J. Med. 306: 194, 1982.PubMedCrossRefGoogle Scholar
  30. 30.
    Scheinman M, Morady F, Hess D, Gonzales R: Catheter induced ablation of the atrioventricular junction to control refractory supraventricular arrhythmias. DAMA 243: 851, 1982.Google Scholar
  31. 31.
    Sealy WC, Gallagher JJ: The surgical approach to the septal area of the heart based on experiences with 45 patients with Kent bundles. J. Thorac. Cardiovasc. Surg. 79: 542, 1980.PubMedGoogle Scholar
  32. 32.
    Spach MS: The electrical representation of cardiac muscle based on discontinuities of atrial resistivity at a microscopic and macroscopic level. A basis for saltatory propagation in cardiac muscle. In Normal and Abnormal Conduction in the Heart de Carvalho AP, Hoffman BF, Lieber-mann M (eds.). Biophysics, Physiology, Pharmacology and Ultrastructure. Mount Kisco, New York. Futura Publishing Company, 1982, pp. 145–153.Google Scholar
  33. 33.
    Klein GJ, Hackel DB, Gallagher JJ: Anatomic substrate of impaired antegrade conduction over an accessory pathway in the Wolff-ParkinsonWhite syndrome. Circulation 61: 1249, 1980.PubMedGoogle Scholar
  34. 34.
    Prystowsky EN, Heger JJ, Jackman WM, Naccarelli GV, Zipes DP: Post-myocardial infarction incessant supraventricular tachycardia due to concealed accessory pathway. Am. Heart J. 103: 426, 1982.PubMedCrossRefGoogle Scholar
  35. 35.
    Rossi L: The pathologic basis of cardiac arrhythmias. Cardiol. Clin. 1: 13, 1983.PubMedCrossRefGoogle Scholar
  36. 36.
    De La Fuente D, Sasyniuk B, Moe GK: Conduction through a narrow isthmus in isolated canine atrial tissue. A model of the WPW syndrome. Circulation 44: 803, 1971.PubMedGoogle Scholar
  37. 37.
    Wolff GS, Sung RJ, Pickoff A, Garcia OL, Werblim R, P Ferrer PL, Tamer D, Gelband H: The fast-slow form of atrioventricular nodal reentrant tachycardia in children, Am. J. Cardiol. 43: 1181, 1979.PubMedCrossRefGoogle Scholar
  38. 38.
    Wellens HJJ, Wesdorp JC, Diiren DR, Lie KI: Second degree block during reciprocal atrioventricular nodal tachycardia. Circulation 53: 595, 1976.PubMedGoogle Scholar
  39. 39.
    Josephson ME and Kastor JA: Paroxysmal supra-ventricular tachycardia. Is the atrium a necessary link? Circulation 54: 430, 1976.PubMedGoogle Scholar
  40. 40.
    Bauernfeind RA, Wu D, Denes P, Rosen GM: Retrograde block during dual pathway atrioventricular nodal reentrant paroxysmal tachycardia. Am. J. Cardiol. 42: 499, 1978.PubMedCrossRefGoogle Scholar
  41. 41.
    Coumel P: Different modes of pacemaking in the long-term management of paroxysmal tachycardia in Symposium on Cardiac Arrhythmias, E Sandoe. E Jlensted-Jenson, and KH Olesen (eds.). AB Astra, Sweden, 1970, pp. 783–806.Google Scholar
  42. 42.
    Critelli G, Monda V, Perticone F, Coltorti F, Scherillo M, Condorelli M: Interruzione a torace chiuso dei fasci anomali di conduzione. Impiego in un caso di tachicardia incessante guidato da un modello sperimentale. G. Ital. Cardiolx. 16: 181, 1984.Google Scholar
  43. 43.
    Fisher JD, Brodman R, Kim SG, Motos JA: Wolff-Parkinson-White syndrome: nonsurgical Kent bundle ablation via the coronary sinus. PACE 6A: 18, 1983.Google Scholar
  44. 44.
    Weber H, Schmitz L: Catheter technique for closed-chest ablation of an accessoary atrioventricular pathway. N. Engl. J. Med. 308: 653, 1983.PubMedGoogle Scholar
  45. 45.
    Morady F, Scheinman MM: Transvenous catheter ablation of a posterior septal accessory pathway in a patient with the Wolff-Parkinson-White syndrome. N. Engl. J. Med. 310: 705, 1984.Google Scholar

Copyright information

© Martinus Nijhoff Publishing 1986

Authors and Affiliations

  • Giuseppe Critelli
  • John J. Gallagher
  • Gaetano Thiene
  • Lino Rossi

There are no affiliations available

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