ATRIAL TACHYCARDIA: DIFFERENTIAL DIAGNOSIS

Case presented by:

MELVIN M. SCHEINMAN, MD

A 59-year-old patient presents with an almost incessant tachycardia. He has no structural cardiac disease and the cardiac echocardiogram is normal. An example of tachycardia initiation is shown in Figure 11.1.

Question No. 1:

1.What are the possible mechanisms for this tachycardia?

A.Atrioventricular nodal reentry tachycardia (AVNRT).

B.Orthodromic reentrant tachycardia.

C.Atrial tachycardia (AT).

2.What is your next therapeutic maneuver?

A.Antiarrhythmic therapy.

B.Electrophysiology (EP) study and catheter ablation.

Question No. 2: The mode of adenosine termination favors:

A.Atrial tachycardia.

B.Atrioventricular nodal reentry tachycardia.

C.Atrioventricular reentry tachycardia (AVRT).

D.Automatic junctional tachycardia.

Figure 11.3. Right atrial foci. CT, crita terminalis, TA, tricuspid annulus, SUP, superior, RAA, right atrial appendage (Reproduced with permission from Teh et al.¹)

P-wave contour in determining the mechanism of the tachycardia?

Question No. 3: Ventricular overdrive pacing is initiated during tachycardia. These observations prove:

A.AT is excluded.

B.AVNRT is a possible mechanism.

C.AVRT is a possible mechanism.

D.The data are not conclusive.

Question No. 4: Pacing from the right ventricle close to the region of the CS:

A.Excludes permanent junctional reciprocating tachycardia (PJRT).

B.Proves AT.

C.Excludes AVNRT.

D.Excludes junctional tachycardia.

Question No. 5: Atrial overdrive pacing from the CS:

A.Proves reentry is present.

B.Excludes a focal tachycardia.

C.Suggests that this is a good site for ablation.

D.Is compatible with a focal tachycardia.

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