A 53-year-old man with palpitations, one episode of syncope, and ventricular preexcitation on surface ECG presented for electrophysiologic study. Baseline sinus cycle length was 1,010 ms, atrial-His (AH) interval 111 ms, and His-ventricular (HV) interval 28 ms. With delivery of atrial extrastimuli, a discrete “jump” in the AH interval was observed (>50 ms with decrement of the extrastimulus by 10 ms), indicating dual node physiology. However, neither echo beats nor supraventricular tachycardia based on this mechanism alone was observed. A premature ventricular complex (PVC) initiated an antidromic atrioventricular reciprocating tachycardia (AVRT) (Figure 1). What is the most likely mechanism of the initiation of this tachycardia?
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- Double atrial response to a single ventricular impulse due to simultaneous conduction via two retrograde pathways.J Am Coll Cardiol. 1985; 5: 168-175
- Two accessory pathways, dual AV nodal conduction, and 1:2 ventriculoatrial conduction in a patient with multiple supraventricular tachycardias.Pacing Clin Electrophysiol. 1990; 13: 171-178
- Double atrial response to a single ventricular extrastimulus in a patient with Wolff-Parkinson-White syndrome.Jpn Heart J. 1992; 33: 259-263
Published online: March 17, 2006
© 2006 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.