Patient with atrioventricular node reentrant tachycardia with eccentric retrograde left-sided activation - Treatment with radiofrequency catheter ablation

We describe a patient with supraventricular tachycardia with triple atriove ntricular (AV) node pathway physiology. A discontinuous curve was present i n the antegrade AV nodal function curves. During right ventricular pacing, the earliest retrograde atrial activation was recorded at the left-sided co ronary sinus electrode, The retrograde ventricular-atrial interval was long and had decremental conduction. We induced a slow-slow AV node reentrant t achycardia (AVNRT) with eccentric retrograde left-sided activation. After s low pathway ablation, dual AV nodal pathway physiology was present. AVNRT w ith eccentric retrograde left-sided activation is relatively rare, and our findings suggest that eccentric retrograde left-sided atrial inputs consist partially of a slow pathway and disappear with slow pathway ablation.