Empirical slow pathway ablation in patients with paroxysmal palpitations and pounding in the neck: A 15-year follow-up

ECG documentation of atrioventricular-nodal re-entrant tachycardia (AVNRT) in patients with paroxysmal tachycardia is not always feasible. Even in patients with documented paroxysmal supraventricular tachycardia (SVT), there are chances that sustained AVNRT will not be induced during electrophysiological study (EPS). Pounding in the neck - flapping or bulging sensation and appearance of neck veins -, also called the “frog sign”, is considered as a classical anamnestic symptom, or when visible, sign due to simultaneous contractions of the atria and ventricles against closed atrioventricular valves during AVNRT 1 Gürsoy S. Steurer G. Brugada J. Andries E. Brugada P. The Hemodynamic Mechanism of Pounding in the Neck in Atrioventricular Nodal Reentrant Tachycardia. New England Journal of Medicine. 1992; 327: 772-774 Crossref PubMed Google Scholar . Our purpose was to evaluate the long-term outcomes of empirical slow-pathway ablation in patients with paroxysmal palpitations and neck pounding but without documented SVT and without inducible SVT (Group A). These patients were compared to a control group of patients undergoing empiric slow-pathway ablation with documented SVT but without inducible SVT (Group B) or AVNRT at EP study but without documented SVT (Group C). Consecutive patients undergoing radiofrequency ablation of the slow pathway between 2007 and 2009 were included in a prospective database.