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Conflicting responses with simultaneous atrioventricular pacing. What is the mechanism?

Year: 2024

Type: article

Abstract: CaseA 60-year-old woman presented with recurrent episodes of palpitations, documented short RP, narrow QRS tachycardia and absence of preexcitation in the electrocardiogram during sinus rhythm.During an electrophysiology study, programmed stimulation induced a narrow QRS tachycardia with cycle length of 380 ms, VA interval of 164 ms and earliest atrial activation in the His region.Ventricular overdrive pacing failed to entrain the atrium even with isoprenaline infusion and atrial burst pacing repeatedly terminated the tachycardia.Difference in AH interval with pacing and SVT was 27 msec.Simultaneous atrial and ventricular pacing was done with atrial pacing from the high right atrium and showed a His signal as the first return electrogram suggestive of atrioventricular nodal reentrant tachycardia (AVNRT).The manoeuvre was repeated with atrial pacing from the proximal coronary sinus and showed an atrial signal as the first return electrogram suggestive of atrial tachycardia (AT).What is the explanation for the conflicting results of the two pacing maneuvers?Peer review under responsibility of Indian Heart Rhythm Society.

Source: Indian Pacing and Electrophysiology Journal

DOI: 10.1016/j.ipej.2024.08.004

Authors: Suresh Kumar Sukumaran, Anish Bhargav, Sridhar Balaguru, Raja J. Selvaraj

Institution: Jawaharlal Institute of Post Graduate Medical Education and Research

Language: English

Topic: Cardiac Arrhythmias and Treatments

Subfield: Cardiology and Cardiovascular Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $550