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The underlying mechanism for stable beat‐to‐beat cycle length variability ( CL  alternans) in scar‐related atrial tachycardia ( AT ) had not been elucidated clearly. We described a case with postoperative dual‐loop reentrant  AT  in right atrium. When the loop depended on cavo‐tricuspid isthmus was blocked by ablation, the  AT  transformed into a  CL  alternate tachycardia. High density and resolution mapping revealed that the  CL  alternans was caused by the alternate conduction velocities at the slow conduct region. A further ablation line was created from the slow conduction zone to the inferior vena cave, and afterward no  AT  was inducible.

journal of arrhythmia

Tachycardia cycle length alternans caused by alternate conduction velocity on the slow conduction zone in a postoperative scar‐related atrial tachycardia