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Long RP Tachycardia with Atrioventricular Block. What is the Tachycardia Mechanism

Michalis Efremidis, Konstantinos Koutras

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Abstract

A 23-year-old woman underwent electrophysiological study because of a 9-year history of frequent episodes of supraventricular tachycardia. The patient had a normal baseline ECG and no structural heart disease. The baseline AH and HV intervals were 70 and 40 msec, respectively. Incremental atrial pacing and ventricular pacing reproducibly induced a narrow QRS complex tachycardia (cycle length 344 ms) with negative P-wave polarity in inferior leads and positive in V1 lead. During the tachycardia the earliest atrial activation was recorded at the ostium of the coronary sinus, where the AH and HA intervals were 95 and 237 ms, respectively (Fig. 1). What is the mechanism of this tachycardia?

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What this paper is about

A 23-year-old woman underwent electrophysiological study because of a 9-year history of frequent episodes of supraventricular tachycardia. The patient had a normal baseline ECG and no structural heart disease. The baseline AH and HV intervals were 70 and 40 msec, respectively. Incremental atrial pacing and ventricular pacing reproducibly induced a narrow QRS complex tachycardia (cycle length 344 ms) with negative P-wave polarity in inferior leads and positive in V1 lead. During the tachycardia the earliest atrial activation was recorded at the ostium of the coronary sinus, where the AH and HA intervals were 95 and 237 ms, respectively (Fig. 1). What is the mechanism of this tachycardia?

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Available abstract

A 23-year-old woman underwent electrophysiological study because of a 9-year history of frequent episodes of supraventricular tachycardia. The patient had a normal baseline ECG and no structural heart disease. The baseline AH and HV intervals were 70 and 40 msec, respectively. Incremental atrial pacing and ventricular pacing reproducibly induced a narrow QRS complex tachycardia (cycle length 344 ms) with negative P-wave polarity in inferior leads and positive in V1 lead. During the tachycardia the earliest atrial activation was recorded at the ostium of the coronary sinus, where the AH and HA intervals were 95 and 237 ms, respectively (Fig. 1). What is the mechanism of this tachycardia?

Key concepts: Medicine, Cardiology, Internal medicine, Tachycardia, Supraventricular tachycardia, Atrioventricular reentrant tachycardia, Electrophysiology study, QRS complex

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