Atrial asystole during ventricular pacing following radiofrequency catheter ablation of accessory pathways.

Sinus node bradycardia or sinus node arrest is a documented phenomenon during radiofrequency catheter ablation. In addition, sinus node inhibition during ventricular pacing has been described as an infrequent occurrence in the course of diagnostic electrophysiology studies. The proposed mechanism in both situations is intense stimulation of vagal afferent pathways leading to a Bezold-Jarisch-like phenomenon. In the present report, we describe a series of three cases of atrial asystole during ventricular pacing following radiofrequency catheter ablation of accessory pathways. Potential pathophysiologic mechanisms are discussed.