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AVNRT

-the sequel no one asked for-

Patient presentation

  • 35 year old female

  • Previous AVNRT ablation (slow pathway modifcation)

  • recurrent palpitations ("feels different")

  • very sympomatic

Retrograde extras

  • Decremental, midline (CS 7,8) VA conduction

  • VA ERP 450ms

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Antegrade extras

  • Decremental AV interval, no jump

  • Repeatable, atypical echo (long VA and CS 56 early)

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Tachycardia induction

  • Atrial burst pacing

  • short RP tachycardia

  • Midline atrial activation (CS 7,8)

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Differentials

  • AVNRT

  • JT

  • ATc

Ventricular entrainment - 390ms

  • Tachycardia termination - unable to see how terminates

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  • 4 fully captured beats to entrain the atrium (AVRT ruled out)

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Tachycardia 2 

  • initiated by atrial burst pacing

  • Long RP tachycardia

  • midline atrial activation (HIS A)

  • TCL 530ms, VA 438ms

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Differentials

  • AVNRT (atypical)

  • JT

  • ATc

  • AVRT

Ventricular entrainment - 500ms

  • Pseudo VAAV response

  • Really is VAV response (ATc ruled out)

  • >1 beat to entrain (inconsistent with AVRT)

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Diagnosis

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