A narrow complex tachycardia with variable R-R intervals: what is the mechanism?
File(s)REVISED JCE R-AVRT report.docx (761.6 KB)
Accepted version
Author(s)
Luther, Vishal
Wright, Ian
Lefroy, David
Ng, F
Type
Journal Article
Abstract
A 46-year-old man was referred for an invasive electrophysiological study with a view to ablation, for a history of classic sudden onset-offset palpitations. The patient’s son had recently survived an out of hospital cardiac arrest, and was found to have an accessory pathway (details unknown) at another institute, which was ablated. Our patient’s 12 lead electrocardiogram (ECG) showed sinus rhythm with no evidence of pre-excitation. Echocardiography revealed a structurally normal heart. An electrophysiological study was performed with a quadripolar catheter positioned at the high right atrium (HRA), a steerable decapolar catheter in the coronary sinus and quadripolar catheters along the His bundle and at the right ventricular apex. Baseline atrio-His (AH) and His-ventricular (HV) intervals measured 60ms and 40ms respectively. Programmed atrial extra-stimulus testing revealed decremental AH intervals, before tachycardia was reproducibly induced. Figure 1 shows the tachycardia on a 12-lead ECG. Figure 2 shows the induction of tachycardia with atrial pacing. Based on the findings within the figures, what is the mechanism of the tachycardia?
Date Issued
2018-08-01
Date Acceptance
2018-04-20
Citation
Journal of Cardiovascular Electrophysiology, 2018, 29 (8), pp.1174-1176
ISSN
1045-3873
Publisher
Wiley
Start Page
1174
End Page
1176
Journal / Book Title
Journal of Cardiovascular Electrophysiology
Volume
29
Issue
8
Copyright Statement
© 2018 Wiley Periodicals, Inc. This is the pre-peer reviewed version of the following article, which has been published in final form at https://onlinelibrary.wiley.com/doi/full/10.1111/jce.13618
Subjects
Science & Technology
Life Sciences & Biomedicine
Cardiac & Cardiovascular Systems
Cardiovascular System & Cardiology
atrial arrhythmias
AVN
clinical: catheter ablation
clinical: electrophysiology
reentry
WPW/AVRT
1102 Cardiovascular Medicine And Haematology
Cardiovascular System & Hematology
Publication Status
Published
Date Publish Online
2018-04-26