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A Wide QRS Complex Tachycardia with Different Initiation Patterns: What is the Mechanism?
Author(s) -
YAMADA TAKUMI,
PLUMB VANCE J,
MCELDERRY HUGH T,
KAY G. NEAL
Publication year - 2007
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.2007.00752.x
Subject(s) - medicine , cardiology , tachycardia , palpitations , qrs complex , electrophysiologic study , ablation , bundle branch block , atrial tachycardia , electrocardiography , anesthesia , catheter ablation
A 47‐year‐old man with palpitations underwent electrophysiologic testing (EPS). Burst atrial pacing while infusing isoproterenol induced non‐reproducible wide QRS tachycardias with an unusual pattern of an H‐A‐V activation with the same tachycardia cycle length and two different initiation patterns. The tachycardia had the earliest atrial activation at the His bundle region. No dual atrioventricular (AV) nodal physiology was demonstrated by programmed atrial stimulation. Though a definite diagnosis of AV nodal reentrant tachycardia was not obtained, slow pathway ablation was performed in order to avoid inadvertent AV block as a complication. Thereafter, no tachycardias were induced by repeat burst atrial pacing.