Featured arrhythmia| Volume 3, ISSUE 7, P865, July 2006

Initiation of antidromic reciprocating tachycardia: What is the mechanism?

      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?
      Figure thumbnail gr1
      Figure 1Induction of an antidromic atrioventricular reciprocating tachycardia with a premature ventricular complex. CS p, CS d, CS 3-4, CS 5-6, and CS 7-8 = proximal, distal, bipole 3-4, bipole 5-6, and bipole 7-8 coronary sinus electrogram, respectively; HIS d and HIS p = distal and proximal His-bundle electrogram, respectively; RVA p = proximal right ventricular electrogram.
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