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Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common regular supraventricular tachycardia. Slow pathway (SP) modification has evolved as the first-line treatment,1,2 with acute success rates of 95% to 98%.  sensitive sign for success of the procedure is observation of accelerated junctional rhythm (JR) during ablation.3 The serious complication of AV block (AVB) can occur, and affects ≈1% to 2.3% of patients during or after catheter ablation procedures.2,4 Some studies have demonstrated that loss of VA conduction during radiofrequency application predicts impending AVB during ablation.5,6 From this illustrative series of cases assembled from 4 large tertiary care centers during a period of 3 years, we analyze some possible reasons for occurrence of AVB, and suggest methods to prevent this complication during SP modification procedures.Editor’s Perspective see p 745 A 58-year-old woman with a history of paroxysmal supraventricular tachycardia was refractory to medical therapy and referred for ablation. The baseline AH and HV intervals were 80 and 50 ms, respectively. Atrial pacing at 600 ms demonstrated fast pathway conduction and jump to SP conduction with a single echo beat (Figure 1A, left).  narrow QRS tachycardia with the same retrograde conduction sequence was induced during isoproterenol infusion, by atrial programmed stimulation (Figure 1A, right), which was diagnosed as AVNRT with cycle length (CL) of 380 ms, AH of 280 ms, HV of 50 ms, and VA of 50ms. No further pacing maneuvers were performed during tachycardia and SP modification was performed guided by fluoroscopy with a power setting of 30 W, temperature 60°C and total duration of 35 s. During radiofrequency delivery, JR with 1:1 retrograde conduction was observed during radiofrequency application with a CL between 500 and 600 ms, and 4 beats of sinus rhythm with …

Atrioventricular Block During Slow Pathway Ablation