NONREENTRANT ATRIOVENTRICULAR NODAL TACHYCARDIA
Case presented by:
A 19-year-old female patient presented with complaints of recurrent palpitation at rest and on exertion for the past 2 years. These episodes were associated with dizziness and lightheadedness. Her medical history included surgery for atrial septal defect at age 4. Her clinical cardiovascular examination was normal.
A two-dimensional (2D) echocardiogram was normal with no evidence of any residual shunt across the atrial septum. A 12-lead ECG (Figure 8.1) is shown below.
Figure 8.1 12-lead ECG showing supraventricular tachycardia (SVT). Note the regularly irregular rhythm with 2 distant RR intervals (closed arrows).
Question No. 1: What is the diagnosis?
A.Atrial fibrillation (AF).
B.Atrial flutter.
C.AV nodal reentrant tachycardia (AVNRT).
D.None of the above.
Subsequently, patient underwent electrophysiology (EP) study. Intracardiac electrogram (EGM) tracings from the study (Figures 8.2 and 8.3) are shown below.
Figure 8.2. Shown from top to bottom are surface ECG leads I, II and V1. HRA, high right atrial; HBp, His bundle proximal; HBm, His bundle mid; HBd, His bundle distal; RVa, right ventricular apex.
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