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Background: Atrioventricular nodal reentrant tachycardia (AVNRT) is treatable by catheter ablation. Advances in mapping‐system technology permit fluoroless workflow during ablations. As national practice trends toward fluoroless approaches, easily obtained, reproducible methods of slow‐pathway identification, and ablation become increasingly important. We present a novel method of slow‐pathway identification and initial ablation results from this method. Methods and Results: We examined AVNRT ablations performed at our institution over a 12‐month period. In these cases, the site of the slow pathway was predicted by latest activation in the inferior triangle of Koch during sinus rhythm. Ablation was performed in this region. Proximity of the predicted site to the successful ablation location, complication rates, and patient outcomes were recorded. Junctional rhythm was seen in 40/41 ablations (98%) at the predicted site (mean, 1.3 lesions and median, 1 lesion per case). One lesion was defined as 5 mm of ablation. The initial ablation was successful in 39/41 cases (95%); in two cases, greater or equal to 2 echo beats were detected after the initial ablation, necessitating further lesion expansion. In 8/41 cases (20%), greater than one lesion was placed during initial ablation before attempted reinduction. Complications included one transient heart block and one transient PR prolongation. During follow‐up (median, day 51), one patient had lower‐extremity deep‐vein thrombosis and pulmonary embolus, and one had a lower‐extremity superficial venous thrombosis. There was one tachycardia recurrence, which prompted a redo ablation. Conclusions: Mapping‐system detection of late‐activation, low‐amplitude voltage during sinus rhythm provides an objective, and fluoroless means of identifying the slow pathway in typical AVNRT. [ABSTRACT FROM AUTHOR]

Permanent junctional reciprocating tachycardia, or atrioventricular reentrant tachycardia utilizing a slowly conducting posteroseptal accessory pathway, is a rare form of reentrant supraventricular tachycardia in children and adults. The characteristic features of this narrow complex tachycardia are a long RP interval and inverted P waves in the inferior leads. This form of accessory-pathway-mediated tachycardia, which is usually incessant, can lead to a tachycardia-induced cardiomyopathy and congestive heart failure if left untreated. Radiofrequency ablation of the accessory pathway in permanent junctional reciprocating tachycardia is the definitive treatment in these patients, and in many instances the effects of prolonged tachycardia on ventricular function are reversible after successful ablation. We present an illustrative case. [ABSTRACT FROM AUTHOR]