Paroxysmal Supraventricular Tachycardia with Idiopathic Pulmonary Arterial Hypertension: A Case Report

There were few reports regarding arrhythmias with idiopathic pulmonary arterial hypertension (IPAH). A 37-year-old woman was presented with a 6-year history of palpitations. She was diagnosed as IPAH at 25 years old and introduced continuous intravenous administration of PGI2 at 27 years old. Her electrocardiogram revealed paroxysmal supraventricular tachycardia (PSVT) and was referred for Catheter ablation. The electrophysiological study revealed dual pathway in AV and VA conduction. PSVT was induced by programmed atrial stimuli with jump up phenomenon under a small amount of isoproterenol. The tachycardia cycle length was from 460 ms to 560 ms, but earliest atrial potential was recorded at His and intra-atrial propagation was similar in any cycle lengths. The single-extra ventricular stimuli did not reset the tachycardia, so we diagnosed as common type AV nodal reentrant tachycardia. Fractionated potential so called slow pathway potential were recorded in broad posteroseptal area and junctional tachycardia was immediately obtained during the applications of radiofrequency current, but it was hard to eliminate the PSVT. After 12 deliveries of radiofrequency current, PSVT could not be induced by any programmed stimuli.