Abstract
c p I H d f “ l d c “ Case presentation A 31-year-old man with a long history of palpitations underwent diagnostic electrophysiologic study. Baseline 12lead electrocardiogram and echocardiography were normal. Atrio-His and His-ventricular intervals measured 83 and 44 ms, respectively. Dual atrioventricular (AV) node physiology was observed during programmed atrial extrastimulation. Spontaneous ventricular premature depolarizations repeatedly induced a long RP-interval supraventricular tachycardia that consistently terminated during attempts to entrain it from the ventricle (Figure 1, top). Retrograde ventriculoatrial (VA) conduction was midline and identical to that during tachycardia, with the response to para-Hisian pacing at a cycle length of 700 ms shown in Figure 1 (bottom). Figures 2 and 3 show reinduction of tachycardia after its termination during attempted entrainment and development of transient right bundle branch block during tachycardia, respectively. Based on these findings, what is the mechanism of tachycardia?
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