A wide QRS complex tachycardia with different initiation patterns: What is the mechanism?

Takumi Yamada; Vance J. Plumb; Hugh T. Mcelderry; G. Neal Kay

doi:10.1111/j.1540-8159.2007.00752.x

A wide QRS complex tachycardia with different initiation patterns: What is the mechanism?

Takumi Yamada, Vance J. Plumb, Hugh T. Mcelderry, G. Neal Kay

Research output: Contribution to journal › Article › peer-review

Abstract

A 47-year-old man with palpitations underwent electrophysiologic testing (EPS). Burst atrial pacing while infusing isoproterenol induced non-reproducible wide QRS tachycardias with an unusual pattern of an H-A-V activation with the same tachycardia cycle length and two different initiation patterns. The tachycardia had the earliest atrial activation at the His bundle region. No dual atrioventricular (AV) nodal physiology was demonstrated by programmed atrial stimulation. Though a definite diagnosis of AV nodal reentrant tachycardia was not obtained, slow pathway ablation was performed in order to avoid inadvertent AV block as a complication. Thereafter, no tachycardias were induced by repeat burst atrial pacing.

Original language	English (US)
Pages (from-to)	796-798
Number of pages	3
Journal	PACE - Pacing and Clinical Electrophysiology
Volume	30
Issue number	6
DOIs	https://doi.org/10.1111/j.1540-8159.2007.00752.x
State	Published - Jun 2007
Externally published	Yes

Keywords

Atrioventricular nodal reentrant tachycardia
Dual response
Radiofrequency catheter ablation
Slow pathway

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10.1111/j.1540-8159.2007.00752.x

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title = "A wide QRS complex tachycardia with different initiation patterns: What is the mechanism?",

abstract = "A 47-year-old man with palpitations underwent electrophysiologic testing (EPS). Burst atrial pacing while infusing isoproterenol induced non-reproducible wide QRS tachycardias with an unusual pattern of an H-A-V activation with the same tachycardia cycle length and two different initiation patterns. The tachycardia had the earliest atrial activation at the His bundle region. No dual atrioventricular (AV) nodal physiology was demonstrated by programmed atrial stimulation. Though a definite diagnosis of AV nodal reentrant tachycardia was not obtained, slow pathway ablation was performed in order to avoid inadvertent AV block as a complication. Thereafter, no tachycardias were induced by repeat burst atrial pacing.",

keywords = "Atrioventricular nodal reentrant tachycardia, Dual response, Radiofrequency catheter ablation, Slow pathway",

author = "Takumi Yamada and Plumb, {Vance J.} and Mcelderry, {Hugh T.} and Kay, {G. Neal}",

year = "2007",

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language = "English (US)",

volume = "30",

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journal = "PACE - Pacing and Clinical Electrophysiology",

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AU - Yamada, Takumi

AU - Plumb, Vance J.

AU - Mcelderry, Hugh T.

AU - Kay, G. Neal

PY - 2007/6

Y1 - 2007/6

N2 - A 47-year-old man with palpitations underwent electrophysiologic testing (EPS). Burst atrial pacing while infusing isoproterenol induced non-reproducible wide QRS tachycardias with an unusual pattern of an H-A-V activation with the same tachycardia cycle length and two different initiation patterns. The tachycardia had the earliest atrial activation at the His bundle region. No dual atrioventricular (AV) nodal physiology was demonstrated by programmed atrial stimulation. Though a definite diagnosis of AV nodal reentrant tachycardia was not obtained, slow pathway ablation was performed in order to avoid inadvertent AV block as a complication. Thereafter, no tachycardias were induced by repeat burst atrial pacing.

AB - A 47-year-old man with palpitations underwent electrophysiologic testing (EPS). Burst atrial pacing while infusing isoproterenol induced non-reproducible wide QRS tachycardias with an unusual pattern of an H-A-V activation with the same tachycardia cycle length and two different initiation patterns. The tachycardia had the earliest atrial activation at the His bundle region. No dual atrioventricular (AV) nodal physiology was demonstrated by programmed atrial stimulation. Though a definite diagnosis of AV nodal reentrant tachycardia was not obtained, slow pathway ablation was performed in order to avoid inadvertent AV block as a complication. Thereafter, no tachycardias were induced by repeat burst atrial pacing.

KW - Atrioventricular nodal reentrant tachycardia

KW - Dual response

KW - Radiofrequency catheter ablation

KW - Slow pathway

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