Permanent junctional reciprocating tachycardia (PJRT) is a rare cardiac arrhythmia. It is a supraventricular tachycardia, and a cause of atrioventricular reentrant tachycardia (AVRT). PJRT can cause chronic tachycardia that, untreated, leads to cardiomyopathy. The cause is an accessory pathway in the heart which conducts from the ventricles back to the atria. Unlike the accessory pathway in a more common cause of AVRT, Wolff–Parkinson–White syndrome, the accessory pathway in PJRT conducts slowly. This means that the associated tachycardia may be subclinical and only diagnosed at a late stage, after significant damage to the heart has been caused from prolonged and recurrent episodes of AVRT. Symptoms
Palpitations during exercise or stress may be the presenting symptom. Because the initial symptoms are often mild, there may be significant myocardial damage at the time of diagnosis. It is therefore possible for these patients to present with the symptoms of heart failure, such as shortness of breath, fatigue and  oedema (fluid retention). Cause
In-between episodes there is normal electrical conduction in the heart. During an episode of AVRT caused by PJRT, the accessory pathway conducts electrical activity from the ventricles directly back to the atria at the end of systole, which triggers the atria to contract, and the current to pass back to the ventricles again via the atrioventricular node (AV node); see diagram. Diagnosis
There may be no signs outside of an episode.
Presence of a trigger area in the posterior wall of the auditory canal
C. Not attributed to another disorder

Treatment
Pharmacological
A trial of the anticonvulsant drug carbamazepine is common for patients diagnosed with GN. For patients who do not tolerate or respond to carbamazepine, alternative drugs include oxcarbazepine, gabapentin, phenytoin, lamotrigine, and baclofen. In addition, tricyclics (e.g., amitriptyline) and pregabalin are useful in other types of neuropathic pain. Surgical
A variety of surgeries have been performed including microvascular decompression (MVD) of the fifth, ninth, and tenth nerves; as well as partial cutting of the nervus intermedius, geniculate ganglion, chorda tympani and/or the ninth and tenth cranial nerves. References


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