Abstract
Case presentation A 61-year-old man with hypertension, diabetes, and obstructive sleep apnea had a history of intermittent palpitations for 30 years that progressively increased in frequency and duration. The patient underwent an invasive electrophysiologic study, during which pacing from the right ventricular apex demonstrated earliest retrograde atrial activation along the posterior paraseptal region. Administration of intravenous adenosine (12 mg) during ventricular pacing is shown in Figure 1. There was no evidence of anterograde dual atrioventricular (AV) nodal physiology or anterograde preexcitation. Sustained supraventricular tachycardia (SVT) at a cycle length of 370 ms was induced in the baseline state with a single premature ventricular extrastimulus (Figure 2). An example of tachycardia response to a premature extrastimulus is shown in Figure 3A. What is the mechanism of the tachycardia?
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