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Discordant Pacing Manoeuvers and a Narrow QRS Tachycardia – What is the Tachycardia Mechanism?
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A 24-year-old female underwent an electrophysiological study because of recurrent episodes of drug-refractory, paroxysmal supraventricular tachycardia. During adrenergic stress, a narrow QRS tachycardia with eccentric atrial activation was reproducibly inducible. The response to premature ventricular extrastimulation during tachycardia suggested the presence of a slowly conducting accessory pathway. However, a comprehensive appraisal of the electrophysiological study delineated the tachycardia substrate as an atypical atrioventricular nodal reentrant tachycardia in the presence of a bystander nodofascicular pathway. Careful analysing of the basal pacing manoeuvers during sinus rhythm (para-Hisian and differential ventricular pacing) was crucial to establish the correct diagnosis and to avoid unnecessary left-side access to ablate this tachycardia.
Title: Discordant Pacing Manoeuvers and a Narrow QRS Tachycardia – What is the Tachycardia Mechanism?
Description:
A 24-year-old female underwent an electrophysiological study because of recurrent episodes of drug-refractory, paroxysmal supraventricular tachycardia.
During adrenergic stress, a narrow QRS tachycardia with eccentric atrial activation was reproducibly inducible.
The response to premature ventricular extrastimulation during tachycardia suggested the presence of a slowly conducting accessory pathway.
However, a comprehensive appraisal of the electrophysiological study delineated the tachycardia substrate as an atypical atrioventricular nodal reentrant tachycardia in the presence of a bystander nodofascicular pathway.
Careful analysing of the basal pacing manoeuvers during sinus rhythm (para-Hisian and differential ventricular pacing) was crucial to establish the correct diagnosis and to avoid unnecessary left-side access to ablate this tachycardia.
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