Recognizing and managing permanent junctional reciprocating tachycardia in the catheter ablation era.

There is general agreement that an orthodromic AV reentry using a concealed slow conducting accessory pathway as the retrograde limb of the circuit constitutes the underlying mechanism of the permanent form of junctional reciprocating tachycardia (PJRT). In this arrhythmia, the standard ECG typically shows a "long R-P' tachycardia" with retrograde P wave negative in the inferior leads. A careful electrophysiologic evaluation is necessary to confirm the diagnosis of PJRT. Recent reports have demonstrated that the radiofrequency current catheter technique provides a safe and highly effective therapeutic tool for patients suffering from this arrhythmia.