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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Surface ECG &#40;aVF&#44; V1 and V6&#41; and intracardiac bipolar recordings during tachycardia&#46; A supraventricular tachycardia with a long RP interval and earliest atrial activation along the mitral annulus &#40;CS1&#8211;2&#41; is seen&#59; &#40;B&#41; ventricular extrastimuli at shorter coupling intervals from the right ventricle at a time when the His bundle is known to refractorily terminate the tachycardia without reaching the atrium&#59; &#40;C&#41; the tachycardia is induced with a single premature beat from the left ventricle&#44; showing slow and decremental conduction properties&#46; Abl&#58; ablation&#59; CS&#58; coronary sinus &#40;1&#8211;2 distal&#59; 9&#8211;10 proximal&#41;&#59; His p&#58; proximal His&#59; His d&#58; distal His&#59; RVAp&#58; right ventricular apex&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Permanent junctional reciprocating tachycardia &#40;PJRT&#41; is an uncommon form of atrioventricular &#40;AV&#41; reentrant tachycardia due to the presence of an accessory pathway &#40;AP&#41; characterized by slow and decremental retrograde conduction&#44; and usually occurs in children and young adults&#46; The hallmark ECG feature is an incessant narrow complex tachycardia with inverted P waves in leads II&#44; III and aVF&#44; as well as the left lateral leads&#44; and an RP interval longer than the PR interval&#46; Although most APs in PJRT are located in the posteroseptal zone&#44; other locations have been described&#46; It should be noted that this tachycardia is generally incessant and slower than common supraventricular tachycardias&#44; hence correct diagnosis is very important due to the inherent risk of left ventricular dysfunction secondary to tachycardiomyopathy&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case report</span><p id="par0010" class="elsevierStylePara elsevierViewall">A 72-year-old woman with a history of frequent episodes of palpitations since childhood had been diagnosed as having &#8216;bradycardia-tachycardia syndrome&#8217; &#40;sick sinus syndrome&#41; followed by pacemaker implantation five years previously&#46; She complained of dyspnea with minimal exertion and permanent fast heart rate&#46; The patient stated that she had actually felt worse since the pacemaker implantation&#46; During the pacemaker interrogation repetitive induction of a narrow QRS tachycardia was seen during measurement of the ventricular threshold&#44; with a single extra beat &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;&#46; The ECG showed a narrow QRS tachycardia of 125 bpm&#44; negative P waves in the inferior leads&#44; I and aVL&#44; positive in V1&#44; and long RP intervals&#46; Moreover&#44; multiple episodes of incessant narrow QRS tachycardia were also documented by the pacemaker&#44; frequently initiated after a pacing beat&#46; The echocardiogram showed impaired left ventricular ejection fraction&#46; With the suspicion of tachycardiomyopathy &#40;the percentage of ventricular pacing was less than 1&#37;&#44; ruling out right ventricular apical pacing-related heart failure&#41;&#44; the patient was referred for electrophysiology study&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">After written informed consent was obtained&#44; the ablation procedure was performed under deep sedation in a fasting and drug-free state&#46; The patient had been in incessant tachycardia since her arrival in the electrophysiology laboratory&#46; Three standard diagnostic catheters were introduced via the femoral veins and placed in the His bundle&#44; right ventricle and coronary sinus&#46; Long RP tachycardia was confirmed &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>A&#41;&#44; with a distal to proximal atrial activation sequence in the coronary sinus &#40;CS&#41; &#40;earliest atrial activation being located at the distal electrode pair of the CS catheter&#41;&#44; 1&#58;1 AV relationship&#44; AV interval of 270 ms&#44; HH changes preceding and predicting AA changes&#44; and spontaneous termination of the tachycardia ending with ventricular activation&#46; The tachycardia was also inducible by atrial pacing and single ventricular premature beats &#40;VPBs&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;&#46; Moreover&#44; the tachycardia could not be entrained since it was repeatedly interrupted by continuous ventricular pacing&#46; Tachycardia onset was not preceded by AH prolongation and notably&#44; the &#916;AH &#40;difference between atrial pacing AH near tachycardia cycle length and supraventricular tachycardia AH&#41; was 13 ms&#44; ruling out AV nodal reentrant tachycardia with left-sided extension&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> Atrial activation was excluded by showing termination of the tachycardia with a single His-refractory VPB &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>B&#41; without atrial depolarization and fused VPBs&#44; ruling in atrioventricular reciprocating tachycardia mediated by a left lateral AP&#46; Furthermore&#44; the atrial activation sequence during tachycardia was identical to that of right ventricular pacing&#46; The retrograde AP conduction was slow and decremental &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>D&#41;&#46; With this information&#44; a diagnosis was made of PJRT due to an AP with retrograde&#44; slow&#44; and decremental conduction properties&#44; located in the left lateral region&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Via a retrograde approach&#44; careful mapping of the mitral annulus showed an early atrial activation site &#40;15 ms before P-wave onset and 20 ms before CS1&#8211;2&#41; in the lateral region&#46; The ablation catheter electrogram showed an A&#47;V ratio &#62;2 &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>A&#41;&#46; Conventional radiofrequency &#40;RF&#41; application at this site &#40;55<span class="elsevierStyleHsp" style=""></span>&#176;C&#44; 45 W&#41; terminated the tachycardia &#40;within four seconds&#41; with a retrograde block over the AP&#46; After RF ablation the tachycardia was no longer inducible and normal AV node conduction was preserved but without retrograde conduction&#46; No recurrence was observed over six-month follow-up &#40;no events on pacemaker interrogation&#41; and left ventricular ejection fraction increased to normal values&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0025" class="elsevierStylePara elsevierViewall">Differential diagnosis of long RP tachycardias includes PJRT&#44; atypical AV nodal reentrant tachycardia and atrial tachycardia&#46; AV nodal reentrant tachycardia usually initiates after a premature beat depending on a critical AH prolongation&#59; also possible&#44; although rare&#44; is a distal to proximal activation sequence&#44; as seen in the present case&#46; Atrial tachycardia was excluded by reproducible tachycardia termination delivering a single VPB without atrial capture and by the fact that the atrial activation sequence during tachycardia was identical to that of right ventricular pacing&#44; confirming retrograde conduction over an AP&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">In most cases of PJRT the AP is located in the right posteroseptal region around or just within the coronary sinus ostium&#44; but other atypical locations have been reported&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#8211;4</span></a> For instance&#44; various regions of the mitral or tricuspid annuli&#44; except the right posteroseptal region&#44; have been identified in 10&#37; of patients&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Among these locations&#44; the right anterior septum and left posteroseptal regions are seen more frequently&#46; There is no report in the literature of PJRT in an adult patient due to a left lateral AP&#46; One theory for the decremental properties and long conduction times of the PJRT pathway is that the fibers may have a tortuous course as they cross the AV sulcus&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">PJRT is highly refractory to antiarrhythmic drug therapy&#44; because conduction intervals may be prolonged without creating a conduction block in either the antegrade AV node or the retrograde AP&#44; thus failing to control the tachycardia&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> It may also lead to tachycardia-induced cardiomyopathy in some patients&#44; as in the case presented&#46; For these reasons&#44; RF catheter ablation is considered the treatment of choice in PJRT&#46; Ablation procedures for PJRT must involve careful mapping of both AV grooves&#44; looking for the point of earliest atrial activation and&#44; if possible&#44; an AP potential contiguous with the atrial electrogram&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Ethical disclosures</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Protection of human and animal subjects</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors declare that the procedures followed were in accordance with the regulations of the relevant clinical research ethics committee and with those of the Code of Ethics of the World Medical Association &#40;Declaration of Helsinki&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Confidentiality of data</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Right to privacy and informed consent</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors have obtained the written informed consent of the patients or subjects mentioned in the article&#46; The corresponding author is in possession of this document&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflicts of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Permanent junctional reciprocating tachycardia &#40;PJRT&#41; is an uncommon form of atrioventricular reentrant tachycardia due to an accessory pathway characterized by slow and decremental retrograde conduction&#46; The majority of accessory pathways in PJRT are located in the posteroseptal zone&#46; Few cases of atypical location have been described&#46; We report a case of PJRT in a 72-year-old woman in whom the accessory pathway was located in the left lateral region and treated by radiofrequency catheter ablation&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A forma permanente de taquicardia juncional reciprocante &#233; uma modalidade incomum de taquicardia auriculoventricular reentrante devida a via de acesso caracterizada por condu&#231;&#227;o retr&#243;gada lenta e gradual&#46; A maioria das vias acess&#243;rias na forma permanente da taquicardia juncional reciprocante est&#225; localizada na zona posterosseptal&#46; Foram apresentados poucos casos de localiza&#231;&#227;o at&#237;pica1-4&#46; Apresentamos o caso de forma permanente da taquicardia junctional reciprocante numa mulher de 72 anos na qual a via acess&#243;ria foi colocada na regi&#227;o lateral esquerda sendo a abla&#231;&#227;o efetuada por cateter de radiofrequ&#234;ncia&#46;</p></span>"
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">12-lead ECG obtained during sinus rhythm&#44; showing a normal PR interval with no delta waves&#46; Tachycardia is then induced with a single extra beat from the right ventricular apex&#44; exhibiting narrow QRS complexes&#44; long RP intervals&#44; and inverted P waves in the inferior leads&#44; I and aVL and positive in V1&#46;</p>"
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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Surface ECG &#40;aVF&#44; V1 and V6&#41; and intracardiac bipolar recordings during tachycardia&#46; A supraventricular tachycardia with a long RP interval and earliest atrial activation along the mitral annulus &#40;CS1&#8211;2&#41; is seen&#59; &#40;B&#41; ventricular extrastimuli at shorter coupling intervals from the right ventricle at a time when the His bundle is known to refractorily terminate the tachycardia without reaching the atrium&#59; &#40;C&#41; the tachycardia is induced with a single premature beat from the left ventricle&#44; showing slow and decremental conduction properties&#46; Abl&#58; ablation&#59; CS&#58; coronary sinus &#40;1&#8211;2 distal&#59; 9&#8211;10 proximal&#41;&#59; His p&#58; proximal His&#59; His d&#58; distal His&#59; RVAp&#58; right ventricular apex&#46;</p>"
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          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Successful ablation site&#46; The ablation catheter electrogram during tachycardia showed early atrial activation preceding P-wave onset by 15&#8211;20 ms&#44; A&#47;V ratio &#62;2&#59; &#40;B&#41; radiograms obtained in right anterior oblique &#40;30&#176;&#41; and left anterior oblique &#40;45&#176;&#41; projections showing the successful ablation site in the left lateral region at the mitral annulus&#59; &#40;C&#41; the tachycardia was terminated within four seconds of radiofrequency application&#59; &#40;D&#41; absence of ventriculoatrial conduction after ablation&#46; Abbreviations as for <a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>&#46;</p>"
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Case report
Permanent junctional reciprocating tachycardia in a patient with an atypically located accessory pathway in the left lateral mitral annulus
Taquicardia juncional permanente reciprocante numa doente com via acessória de localização atípica no anel mitral lateral esquerdo
Moisés Rodríguez-Mañero
Corresponding author
moirmanero@gmail.com

Corresponding author.
, Xesús A. Fernández-López, Laila González-Melchor, Javier García-Seara, Jose Luis Martínez-Sande, José Ramón González-Juanatey
Arrhythmias Unit, Cardiology Department, University Hospital of Santiago de Compostela, Galicia, Spain
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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Surface ECG &#40;aVF&#44; V1 and V6&#41; and intracardiac bipolar recordings during tachycardia&#46; A supraventricular tachycardia with a long RP interval and earliest atrial activation along the mitral annulus &#40;CS1&#8211;2&#41; is seen&#59; &#40;B&#41; ventricular extrastimuli at shorter coupling intervals from the right ventricle at a time when the His bundle is known to refractorily terminate the tachycardia without reaching the atrium&#59; &#40;C&#41; the tachycardia is induced with a single premature beat from the left ventricle&#44; showing slow and decremental conduction properties&#46; Abl&#58; ablation&#59; CS&#58; coronary sinus &#40;1&#8211;2 distal&#59; 9&#8211;10 proximal&#41;&#59; His p&#58; proximal His&#59; His d&#58; distal His&#59; RVAp&#58; right ventricular apex&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Permanent junctional reciprocating tachycardia &#40;PJRT&#41; is an uncommon form of atrioventricular &#40;AV&#41; reentrant tachycardia due to the presence of an accessory pathway &#40;AP&#41; characterized by slow and decremental retrograde conduction&#44; and usually occurs in children and young adults&#46; The hallmark ECG feature is an incessant narrow complex tachycardia with inverted P waves in leads II&#44; III and aVF&#44; as well as the left lateral leads&#44; and an RP interval longer than the PR interval&#46; Although most APs in PJRT are located in the posteroseptal zone&#44; other locations have been described&#46; It should be noted that this tachycardia is generally incessant and slower than common supraventricular tachycardias&#44; hence correct diagnosis is very important due to the inherent risk of left ventricular dysfunction secondary to tachycardiomyopathy&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case report</span><p id="par0010" class="elsevierStylePara elsevierViewall">A 72-year-old woman with a history of frequent episodes of palpitations since childhood had been diagnosed as having &#8216;bradycardia-tachycardia syndrome&#8217; &#40;sick sinus syndrome&#41; followed by pacemaker implantation five years previously&#46; She complained of dyspnea with minimal exertion and permanent fast heart rate&#46; The patient stated that she had actually felt worse since the pacemaker implantation&#46; During the pacemaker interrogation repetitive induction of a narrow QRS tachycardia was seen during measurement of the ventricular threshold&#44; with a single extra beat &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;&#46; The ECG showed a narrow QRS tachycardia of 125 bpm&#44; negative P waves in the inferior leads&#44; I and aVL&#44; positive in V1&#44; and long RP intervals&#46; Moreover&#44; multiple episodes of incessant narrow QRS tachycardia were also documented by the pacemaker&#44; frequently initiated after a pacing beat&#46; The echocardiogram showed impaired left ventricular ejection fraction&#46; With the suspicion of tachycardiomyopathy &#40;the percentage of ventricular pacing was less than 1&#37;&#44; ruling out right ventricular apical pacing-related heart failure&#41;&#44; the patient was referred for electrophysiology study&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">After written informed consent was obtained&#44; the ablation procedure was performed under deep sedation in a fasting and drug-free state&#46; The patient had been in incessant tachycardia since her arrival in the electrophysiology laboratory&#46; Three standard diagnostic catheters were introduced via the femoral veins and placed in the His bundle&#44; right ventricle and coronary sinus&#46; Long RP tachycardia was confirmed &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>A&#41;&#44; with a distal to proximal atrial activation sequence in the coronary sinus &#40;CS&#41; &#40;earliest atrial activation being located at the distal electrode pair of the CS catheter&#41;&#44; 1&#58;1 AV relationship&#44; AV interval of 270 ms&#44; HH changes preceding and predicting AA changes&#44; and spontaneous termination of the tachycardia ending with ventricular activation&#46; The tachycardia was also inducible by atrial pacing and single ventricular premature beats &#40;VPBs&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;&#46; Moreover&#44; the tachycardia could not be entrained since it was repeatedly interrupted by continuous ventricular pacing&#46; Tachycardia onset was not preceded by AH prolongation and notably&#44; the &#916;AH &#40;difference between atrial pacing AH near tachycardia cycle length and supraventricular tachycardia AH&#41; was 13 ms&#44; ruling out AV nodal reentrant tachycardia with left-sided extension&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> Atrial activation was excluded by showing termination of the tachycardia with a single His-refractory VPB &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>B&#41; without atrial depolarization and fused VPBs&#44; ruling in atrioventricular reciprocating tachycardia mediated by a left lateral AP&#46; Furthermore&#44; the atrial activation sequence during tachycardia was identical to that of right ventricular pacing&#46; The retrograde AP conduction was slow and decremental &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>D&#41;&#46; With this information&#44; a diagnosis was made of PJRT due to an AP with retrograde&#44; slow&#44; and decremental conduction properties&#44; located in the left lateral region&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Via a retrograde approach&#44; careful mapping of the mitral annulus showed an early atrial activation site &#40;15 ms before P-wave onset and 20 ms before CS1&#8211;2&#41; in the lateral region&#46; The ablation catheter electrogram showed an A&#47;V ratio &#62;2 &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>A&#41;&#46; Conventional radiofrequency &#40;RF&#41; application at this site &#40;55<span class="elsevierStyleHsp" style=""></span>&#176;C&#44; 45 W&#41; terminated the tachycardia &#40;within four seconds&#41; with a retrograde block over the AP&#46; After RF ablation the tachycardia was no longer inducible and normal AV node conduction was preserved but without retrograde conduction&#46; No recurrence was observed over six-month follow-up &#40;no events on pacemaker interrogation&#41; and left ventricular ejection fraction increased to normal values&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0025" class="elsevierStylePara elsevierViewall">Differential diagnosis of long RP tachycardias includes PJRT&#44; atypical AV nodal reentrant tachycardia and atrial tachycardia&#46; AV nodal reentrant tachycardia usually initiates after a premature beat depending on a critical AH prolongation&#59; also possible&#44; although rare&#44; is a distal to proximal activation sequence&#44; as seen in the present case&#46; Atrial tachycardia was excluded by reproducible tachycardia termination delivering a single VPB without atrial capture and by the fact that the atrial activation sequence during tachycardia was identical to that of right ventricular pacing&#44; confirming retrograde conduction over an AP&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">In most cases of PJRT the AP is located in the right posteroseptal region around or just within the coronary sinus ostium&#44; but other atypical locations have been reported&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#8211;4</span></a> For instance&#44; various regions of the mitral or tricuspid annuli&#44; except the right posteroseptal region&#44; have been identified in 10&#37; of patients&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Among these locations&#44; the right anterior septum and left posteroseptal regions are seen more frequently&#46; There is no report in the literature of PJRT in an adult patient due to a left lateral AP&#46; One theory for the decremental properties and long conduction times of the PJRT pathway is that the fibers may have a tortuous course as they cross the AV sulcus&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">PJRT is highly refractory to antiarrhythmic drug therapy&#44; because conduction intervals may be prolonged without creating a conduction block in either the antegrade AV node or the retrograde AP&#44; thus failing to control the tachycardia&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> It may also lead to tachycardia-induced cardiomyopathy in some patients&#44; as in the case presented&#46; For these reasons&#44; RF catheter ablation is considered the treatment of choice in PJRT&#46; Ablation procedures for PJRT must involve careful mapping of both AV grooves&#44; looking for the point of earliest atrial activation and&#44; if possible&#44; an AP potential contiguous with the atrial electrogram&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Ethical disclosures</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Protection of human and animal subjects</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors declare that the procedures followed were in accordance with the regulations of the relevant clinical research ethics committee and with those of the Code of Ethics of the World Medical Association &#40;Declaration of Helsinki&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Confidentiality of data</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Right to privacy and informed consent</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors have obtained the written informed consent of the patients or subjects mentioned in the article&#46; The corresponding author is in possession of this document&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflicts of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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            0 => "Permanent junctional reciprocating tachycardia"
            1 => "Catheter ablation"
            2 => "Accessory pathway"
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            0 => "Taquicardia permanente juncional reciprocante"
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            2 => "Via de acesso"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Permanent junctional reciprocating tachycardia &#40;PJRT&#41; is an uncommon form of atrioventricular reentrant tachycardia due to an accessory pathway characterized by slow and decremental retrograde conduction&#46; The majority of accessory pathways in PJRT are located in the posteroseptal zone&#46; Few cases of atypical location have been described&#46; We report a case of PJRT in a 72-year-old woman in whom the accessory pathway was located in the left lateral region and treated by radiofrequency catheter ablation&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A forma permanente de taquicardia juncional reciprocante &#233; uma modalidade incomum de taquicardia auriculoventricular reentrante devida a via de acesso caracterizada por condu&#231;&#227;o retr&#243;gada lenta e gradual&#46; A maioria das vias acess&#243;rias na forma permanente da taquicardia juncional reciprocante est&#225; localizada na zona posterosseptal&#46; Foram apresentados poucos casos de localiza&#231;&#227;o at&#237;pica1-4&#46; Apresentamos o caso de forma permanente da taquicardia junctional reciprocante numa mulher de 72 anos na qual a via acess&#243;ria foi colocada na regi&#227;o lateral esquerda sendo a abla&#231;&#227;o efetuada por cateter de radiofrequ&#234;ncia&#46;</p></span>"
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">12-lead ECG obtained during sinus rhythm&#44; showing a normal PR interval with no delta waves&#46; Tachycardia is then induced with a single extra beat from the right ventricular apex&#44; exhibiting narrow QRS complexes&#44; long RP intervals&#44; and inverted P waves in the inferior leads&#44; I and aVL and positive in V1&#46;</p>"
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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Surface ECG &#40;aVF&#44; V1 and V6&#41; and intracardiac bipolar recordings during tachycardia&#46; A supraventricular tachycardia with a long RP interval and earliest atrial activation along the mitral annulus &#40;CS1&#8211;2&#41; is seen&#59; &#40;B&#41; ventricular extrastimuli at shorter coupling intervals from the right ventricle at a time when the His bundle is known to refractorily terminate the tachycardia without reaching the atrium&#59; &#40;C&#41; the tachycardia is induced with a single premature beat from the left ventricle&#44; showing slow and decremental conduction properties&#46; Abl&#58; ablation&#59; CS&#58; coronary sinus &#40;1&#8211;2 distal&#59; 9&#8211;10 proximal&#41;&#59; His p&#58; proximal His&#59; His d&#58; distal His&#59; RVAp&#58; right ventricular apex&#46;</p>"
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          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Successful ablation site&#46; The ablation catheter electrogram during tachycardia showed early atrial activation preceding P-wave onset by 15&#8211;20 ms&#44; A&#47;V ratio &#62;2&#59; &#40;B&#41; radiograms obtained in right anterior oblique &#40;30&#176;&#41; and left anterior oblique &#40;45&#176;&#41; projections showing the successful ablation site in the left lateral region at the mitral annulus&#59; &#40;C&#41; the tachycardia was terminated within four seconds of radiofrequency application&#59; &#40;D&#41; absence of ventriculoatrial conduction after ablation&#46; Abbreviations as for <a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>&#46;</p>"
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                      "titulo" => "Permanent form of junctional reciprocating tachycardia in adults&#58; peculiar features and results of radiofrequency catheter ablation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46; Meiltz"
                            1 => "R&#46; Weber"
                            2 => "F&#46; Halimi"
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                      "doi" => "10.1093/europace/euj007"
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                      "autores" => array:1 [
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                  "contribucion" => array:1 [
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                      "titulo" => "A permanent junctional reciprocating tachycardia with an atypically located accessory pathway successfully ablated from within the middle cardiac vein"
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                        0 => array:2 [
                          "etal" => true
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                            0 => "B&#46; Amasyali"
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                      "autores" => array:1 [
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                            0 => "H&#46; Ali"
                            1 => "L&#46; Vitali-Serdoz"
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                        0 => array:2 [
                          "etal" => true
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                            0 => "R&#46;T&#46; Ho"
                            1 => "D&#46;R&#46; Frisch"
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Article information
ISSN: 21742049
Original language: English
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2022 September 170 57 227
2022 August 129 57 186
2022 July 146 37 183
2022 June 144 35 179
2022 May 147 44 191
2022 April 175 40 215
2022 March 187 53 240
2022 February 169 28 197
2022 January 290 38 328
2021 December 135 34 169
2021 November 199 59 258
2021 October 252 57 309
2021 September 213 44 257
2021 August 221 46 267
2021 July 210 58 268
2021 June 216 38 254
2021 May 267 71 338
2021 April 481 46 527
2021 March 404 35 439
2021 February 348 23 371
2021 January 266 35 301
2020 December 335 29 364
2020 November 360 42 402
2020 October 249 25 274
2020 September 400 25 425
2020 August 371 27 398
2020 July 523 43 566
2020 June 570 25 595
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2020 January 357 41 398
2019 December 363 35 398
2019 November 394 33 427
2019 October 347 41 388
2019 September 391 38 429
2019 August 230 26 256
2019 July 218 30 248
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2019 May 230 40 270
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2019 March 133 34 167
2019 February 150 28 178
2019 January 98 14 112
2018 December 101 23 124
2018 November 113 12 125
2018 October 152 29 181
2018 September 52 13 65
2018 August 37 10 47
2018 July 28 5 33
2018 June 46 11 57
2018 May 61 10 71
2018 April 48 19 67
2018 March 68 8 76
2018 February 17 4 21
2018 January 32 7 39
2017 December 33 7 40
2017 November 36 13 49
2017 October 27 13 40
2017 September 28 11 39
2017 August 43 14 57
2017 July 26 11 37
2017 June 40 23 63
2017 May 36 20 56
2017 April 43 10 53
2017 March 33 38 71
2017 February 29 5 34
2017 January 45 7 52
2016 December 44 13 57
2016 November 32 11 43
2016 October 53 8 61
2016 September 31 8 39
2016 August 37 2 39
2016 July 19 7 26
2016 June 23 8 31
2016 May 32 5 37
2016 April 26 1 27
2016 March 28 23 51
2016 February 43 22 65
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Revista Portuguesa de Cardiologia (English edition)
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