Atrioventricular nodal reentrant tachycardia in a nonagenarian ∼triple traps of AV block∼

Atrioventricular nodal reentrant tachycardia (AVNRT) is a common arrhythmia encountered in clinical practice. Catheter ablation reduces duration of hospitalization and improves quality of life in patients with this arrhythmia.1 AVNRT is occasionally seen in patients at an old age; however, ablation therapy has not been fully investigated in nonagenarians. In patients with a long PR interval at baseline, antegrade fast pathway conduction may be absent and slow pathway ablation for AVNRT can lead to atrioventricular (AV) block.2,3 Bifascicular block at baseline was also recognized as a risk factor for AV block during ablation therapy; however, there are few reports that discuss the combination of both conduction disorders. Here, we report a case of a nonagenarian with AVNRT and trifascicular block including prolonged PR interval treated with cryoablation. Key Teaching Points • Patients with trifascicular block have a high risk of atrioventricular block following slow pathway ablation. • The slow and fast pathways may be located close together in elderly patients. • Cryoablation is feasible in elderly patients with atrioventricular nodal reentrant tachycardia and trifascicular block.