Jonas Gustavsson Syndrome



Imagine yourself at a Toronto Rock lacrosse game. Toronto is winning and everyone is cheering. Everyone is also drinking (as lacrosse fans are wont to do). Your friends and yourself are seated in the crappy corner seats (the SA node) and wish to spread your Rock passion. Your group stands and runs screaming across the row beginning “the wave”. As your group progresses the fans cheer and the wave continues. You complete the first length of boards (the Atria) and after precariously climbing over and through a barrier (the AV node) continue down the opposite side of the arena (the Ventricles).

For Gustavsson’s condition, AVRT, imagine your group gets to the end of their journey and realize Steve is missing. Where did Steve go? And why are all the fans doing the wave again? It turns out that sometime during the first length of the arena Steve spilt his beer, tripped and ended up falling down the stairs into the concession concourse. After stumbling around for awhile he eventually found another stairway, went back into the rink and came careening down the boards to catch up. As he ran by the fans the wave again followed behind.

The SA node, your group in your crappy corner seats, is the pacemaker for the heart. It begins the process that makes different parts of the heart contract at various intervals 60 to 100 times a minute (a heart beat). In the case of AVRT there is a pesky bit of electrical energy that does a detour but eventually reaches the ventricles causing extra beats the SA node did not intend. This is why the rhythm is termed a reentrant tachycardia.

Many people were surprised to hear about an athlete, under such close medical supervision, developing a “heart condition”. AVRT is not like a heart attack or coronary artery disease, the cause in Gustavsson’s case was a structural abnormality. Extra pathways in the heart’s normal conduction system, either in the AV node or in the area that seperates the atria from the ventricles. The treatment he received was radio frequency ablation. Surgeons pass a thin catheter into his femoral vein and feed it up into the atria. After using specialized techniques to localize where the extra pathways are they kill off them off. The procedure is more safer than it sounds as the surgeons can be extremely accurate and do not need to open up the chest wall or the heart.

For a more thorough review check out this video by Dr. Melvin Scheinman. Scheinman is “the guy” when it comes to catheter ablation and was involved in the development of the procedures at UCSF in 1981.

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