Atrioventricular nodal re-entry: prevalence, presentation, management, andnew strategies for intervention in the context of aviation

Atrioventricular nodal re-entrant tachycardia (AVNRT) is a common arrhythmi a accounting for at least 60% of all cases of SVT, often resulting in serio us symptoms and even syncope. AVNRT occurs as a result of re-entry between two AV nodal pathways, one 'fast' and one 'slow'. Recent anatomical studies suggest that the slow pathway may be represented by posterior extensions o f the AV node in the region of the os of the coronary sinus. Radiofrequency ablation of AV node re-entry particularly using the posterior approach has become a widespread and highly successful form of therapy with low complic ation and recurrence rates. On this basis we recommend restricted certifica tion for patients with AVNRT who have been successfully treated in this man ner after 6 months provided certain criteria are met. Unrestricted certific ation after 2 years should be granted if the same criteria are fulfilled.