K. Ajiki et al., NONREENTRANT SUPRAVENTRICULAR TACHYCARDIA DUE TO DOUBLE VENTRICULAR RESPONSE VIA DUAL ATRIOVENTRICULAR NODAL PATHWAYS, Journal of electrocardiology, 29(2), 1996, pp. 155-160
Narrow and wide QRS tachycardias associated with various rhythm distur
bances were recognized during 24-hour ambulatory electrocardiographic
monitoring in a 65-year-old man with coronary artery disease. Laddergr
am analysis revealed the presence of dual atrioventricular nodal pathw
ays. Nonreentrant supraventricular tachycardia due to simultaneous fas
t and slow conduction through the dual atrioventricular nodal pathways
was confirmed by electrophysiologic study. The atrial rate determined
the occurrence of simultaneous conduction, and extrastimulation faile
d to induce a double ventricular response. Enhanced vagal activity was
thought to play a critical role in provoking this phenomenon. Radiofr
equency catheter ablation of the slow pathway eliminated the arrhythmi
as.