Radiofrequency catheter ablation of both atrial ventricular nodal reentrant and atrial ventricular reentrant tachycardia in a single session

Radiofrequency catheter ablation is a new therapeutic approach to treat patients with symptomatic drug-resistant paroxysmal supraventricular tachycardia. Ablation of two accessory atrioventricular pathways in a single session has been frequently described previously. However, ablation in a single session of both the fast pathway, involved in atrial ventricular nodal reentrant tachycardia, and a concealed atrioventricular accessory pathway involved in a circus movement tachycardia has rarely been reported. A 57-year-old man with a grade III aortic incompetence had the infrequent association of atrial ventricular nodal reentrant tachycardia and orthodromic circus movement tachycardia due to a concealed accessory pathway. He presented with drug-resistant reentrant supraventricular tachycardia and, in a single session, underwent a successful radiofrequency catheter ablation of the fast atrial ventricular nodal pathway and a concealed posteroseptal accessory pathway. During a 10-month follow-up he was free of palpitations without any antiarrhythmic therapy and underwent elective aortic valve replacement.