Open AccessFrequent inappropriate implantable cardioverter defibrillator therapy was determined to be dual atrioventricular nodal non-reentrant tachycardia
Author(s) -
Chengming Ma,
Xiaomeng Yin,
Yunlong Xia,
Wenwen Li,
Lianjun Gao,
Shiyu Dai,
Xiaohong Yu
Publication year - 2021
Publication title -
medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.59
H-Index - 148
eISSN - 1536-5964
pISSN - 0025-7974
DOI - 10.1097/md.0000000000025370
Subject(s) - medicine , cardiology , electrophysiology study , ventricular tachycardia , tachycardia , supraventricular tachycardia , implantable cardioverter defibrillator , ejection fraction , palpitations , atrioventricular node , electrocardiography , heart failure , atrial fibrillation , catheter ablation
Rationale: Dual atrioventricular node non-reentrant tachycardia (DAVNNRT) is a rare arrhythmia. We present a case of inappropriate implantable cardioverter defibrillator (ICD) therapy caused by DAVNNRT. DAVNNRT is easily misdiagnosed as atrial fibrillation and is often identified as ventricular tachycardia (VT) by the supraventricular tachycardia-ventricular tachycardia (SVT-VT) discriminator of the ICD. Patient concerns: A 73-year-old man with ischemic heart disease (IHD) presented with palpitations accompanied by dyspnea and syncope. Frequent multifocal premature ventricular beats and non-sustained ventricular tachycardia were observed on ambulatory electrocardiography. The left ventricular ejection fraction decreased to 32%. Diagnosis: He was diagnosed with IHD, heart failure with reduced ejection fraction (HFrEF), and VT. Interventions : Initially, the patient received a single-chamber ICD implantation for secondary prevention of sudden death. He then suffered from inappropriate anti-tachycardia pacing (ATP)/shock therapy many times after the procedure. DAVNNRT was confirmed in an electrophysiology study (EPS), and radiofrequency ablation of the slow pathway successfully terminated this tachycardia. Outcomes: No episode of inappropriate ICD therapy or tachycardia occurred during the follow-up. Lessons: In conclusion, it is essential to have a full understanding of DAVNNRT and eliminate slow pathways for patients with DAVNNRT and be prepared to implant an ICD.