# Severe cardiomyopathy due to permanent junctional reciprocating tachycardia: recovery after catheter ablation?—a case report

## TL;DR

A patient with severe heart dysfunction caused by a rare heart rhythm disorder showed full recovery after catheter ablation to correct the abnormal pathway.

## Contribution

Demonstrates the reversibility of severe cardiomyopathy caused by permanent junctional reciprocating tachycardia through timely catheter ablation.

## Key findings

- Catheter ablation led to immediate termination of tachycardia and early improvement in left ventricular ejection fraction.
- At 6-month follow-up, the patient showed asymptomatic recovery with normalization of heart function and dimensions.
- Electrophysiological study confirmed the diagnosis and guided successful curative therapy.

## Abstract

Permanent junctional reciprocating tachycardia (PJRT) is a rare form of orthodromic atrioventricular reciprocating tachycardia involving a slowly conducting, decremental concealed accessory pathway. Its incessant nature may result in tachycardia-induced cardiomyopathy, which is reversible with timely rhythm control.

A 41-year-old patient presented with progressive exertional dyspnoea and reduced exercise capacity. Continuous electrocardiogram monitoring revealed an incessant long RP narrow QRS tachycardia (heart rate 135 b.p.m.). Echocardiography demonstrated severe LV systolic dysfunction (LVEF 14%) and LV dilatation (LVEDD 63 mm). Coronary angiography and cardiac MRI excluded relevant structural or infiltrative cardiomyopathy. Electrophysiological study confirmed PJRT using a posteroseptal concealed accessory pathway. Catheter ablation at the site of earliest atrial activation resulted in immediate termination of tachycardia and loss of accessory pathway conduction. Post-ablation echocardiography showed early improvement in LVEF to 26%. The patient was discharged on guideline-directed medical therapy for heart failure. At 6-month follow-up, he remained asymptomatic, with no arrhythmia recurrence and recovery of LVEF to 50% with normalization of LV dimensions.

This case highlights the reversibility of severe cardiomyopathy secondary to incessant PJRT. Even in cases with severe LV dysfunction, timely identification and ablation of the accessory pathway can achieve recovery of LV function. Careful electrophysiologic evaluation is essential to differentiate PJRT from other long RP tachycardias and guide curative therapy.