Wide QRS-complex tachycardia with variable VA-conduction: what is the mechanism? |
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Authors: | Hildegard Tanner Takao Sakata Etienne Delacrétaz |
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Affiliation: | Swiss Cardiovascular Center Bern, University Hospital, CH-3010 Bern, Switzerland. |
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Abstract: | We describe the case of a 16-year-old woman with a surgically corrected tetralogy of Fallot presenting with recurrent wide-QRS-complex tachycardia. The tachycardia could be induced and terminated with ventricular stimulation only. QRS morphology during sinus rhythm and tachycardia was identical and variable VA-conduction was observed. Mapping of the tachycardia showed that variations of HH intervals preceded VV intervals. Therefore, a mechanism involving re-entry within the bundle branches was suggested. However, detailed mapping showed cranial to caudal depolarization of the His bundle, leading to the diagnosis of atrioventricular node re-entrant tachycardia. The tachycardia was abolished by radiofrequency catheter ablation of the slow AV nodal pathway. We conclude that variable VA conduction can occur in patients with atrioventricular node re-entrant tachycardia. The atrial tissue is not always an integral part of the re-entrant circuit. |
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Keywords: | Wide-QRS-complex tachycardia Tetralogy of Fallot Catheter ablation AV nodal reentry tachycardia |
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