International Journal of Cardiology, 38 (1993) 293-298 0 1993 Elsevier Scientific Publishers Ireland Ltd. All rights reserved. 0167-5273/93/$06.00 293 CARD10 01641 Late onset atrioventricular nodal tachycardia Milou L. Pentinga, Joan G. Meeder, Harry J.G.M. Crijns, Ebo D. de Muinck, Am C.P. Wiesfeld and Kong I. Lie Department of Cardiology, Thoraxcenter, University Hospital Groningen, The Netherlands (Received 7 September 1992; revision accepted 13 October 1992) AV nodal tachycardia may present at any age, but onset in late adulthood is considered uncommon. To evaluate whether onset of AV nodal tachycardias at older age is related to organic heart disease (possibly setting the stage for re-entry due to degenerative structural changes) 32 consecutive patients with symp- tomatic AV nodal tachycardia were studied. The age at onset of attacks showed a bimodal pattern, with 2 peaks: one between 15 and 35 years (22 patients) and one around 55 years (10 patients). Significantly more older patients had an underlying heart disease (60% versus 14%, P < O.Ol), with coronary artery disease in 4 and hypertensive heart disease in 3. Frequent supraventricular ectopic activity was seen during baseline 24-h ambulatory monitoring in all the older patients, versus in only half of the younger patients (P = 0.005). These results indicate that late onset AV nodal tachycardia (i.e. > age 45 years) is not infre- quent (33%). The frequent supraventricular arrhythmias on one hand and age-related structural AV nodal changes, potentially enhanced by underlying heart disease on the other, both may contribute to the development of late onset re-entrant AV nodal tachycardia. zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLK Introduction AV nodal tachycardia is mostly due to re-entry within the AV node [l-3]. Although patients may develop symptoms due to this syndrome at any age [4], presentation in late adulthood has been thought to be uncommon [5]. Assuming that the substrate for AV nodal re-entry is already present in early life, but deficient [6], onset of attacks of paroxysmal supraventricular tachycardia only at Correspondence to: Harry JGM Crijns, MD, Department of Cardiology, Thoraxcenter, University Hospital Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands. older age supposedly is facilitated by structural changes within the node, setting the stage for re- entry. The purpose of this study is to characterize patients whose initial arrhythmia appeared after the age of 45 years and to investigate the role of organic heart disease in the onset of AV nodal tachycardia in later life. Methods From January 1988 to May 1991, 32 patients with documented symptomatic tachycardias were diagnosed to have sustained AV nodal tachycardia upon electrophysiological study. Patient records