Abstract
A 39-year-old patient without any medical history except episodes of rapid palpitations was referred to our centre for electrophysiology study. Structural heart disease was excluded and the family history was negative for arrhythmias and sudden death. The electrocardiogram (ECG) of one of the episodes can be seen in Fig. 1. A narrow QRS complex tachycardia with a heart rate of 110 beats/min can be observed. In the patient’s medical history tachycardias with faster heart rates were also mentioned. What is the mechanism of this supraventricular tachycardia? Fig. 1 Twelve-lead surface ECG of the tachycardia
Highlights
The ECG shows a narrow QRS tachycardia, without a very fast ventricular rate of 110 beats/min
A rather narrow P wave can be appreciated just after the T wave with a positive deflection in leads V1 to V6, I and aVL and negative deflection in leads II, III and aVF. Another P wave can be found right at the end of the QRS complex, giving rise to a pseudo R wave in lead V1, or RSR1. This pseudo R wave is absent during sinus rhythm (Fig. 2a–c)
Dual AV nodal physiology was observed and with programmed stimulation a typical atrioventricular nodal reentrant tachycardia (AVNRT) with a short AV interval and 1:1 AV relation was induced after two supraventricular extra stimuli with the second clearly conducted over the slow pathway and retrograde conduction over the fast pathway
Summary
The ECG shows a narrow QRS tachycardia, without a very fast ventricular rate of 110 beats/min. The kiss of the girl from Ipanema This article is published with open access at Springerlink.com
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