Atrioventricular nodal re-entry: Prevalence, presentation, management, and new strategies for intervention in the context of aviation

Atrioventricular nodal re-entrant tachycardia (AVNRT) is a common arrhythmia accounting for at least 60% of all cases of SVT, often resulting in serious 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 of 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 complication and recurrence rates. On this basis we recommend restricted certification for patients with AVNRT who have been successfully treated in this manner after 6 months provided certain criteria are met. Unrestricted certification after 2 years should be granted if the same criteria are fulfilled.