Abstract
Introduction: Dual atrioventricular (AV) node physiology is the substrate for atrioventricular nodal re-entrant tachycardia but electrophysiological manifestation may be dierent in this group of patients. Case Presentation: A 44-year-old male known case of coronary artery disease from one year ago presented with frequent palpita- tion that was refractory to anti-arrhythmic drugs. On surface electrocardiogram (ECG), there was one P wave preceding two up to four consecutive QRS complexes. An electrophysiological study was performed and dual AV node physiology in combination with concealed AV node conduction was confirmed. There was unsuccessful radiofrequency ablation (RFA) application in the right pos- teroseptal area but in second try, successful RFA application was performed in the left posteroseptal area. Conclusions: Dual ventricular response in dual atrioventricular nodal (AVN) physiology is not the usual presentation and may be misdiagnosed with other rhythm disorders. Considering the typical finding on surface ECG and the exact electrophysiological study, the true diagnosis and management could be done in suspected cases.
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