A patient with refractory paroxysmal atrioventricular nodal re-entrant tachycardia had required direct current cardioversion to terminate attacks on 83 occasions. A dual demand pacemaker was implanted to sense and interrupt attacks of tachycardia automatically. The pacing electrode was positioned in the proximal coronary sinus near to the atrioventricular node; a site from which fixed rate underdrive pacing successfully interrupted attacks throughout a trial period of one week, with a lead left in this position on a temporary basis. Complete control of the arrhythmia was obtained in the six months after pacemaker implantation.
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