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

A 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?

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Journal
Indian Pacing and Electrophysiology Journal
Published
2024-08-23
DOI
https://doi.org/10.1016/j.ipej.2024.08.004
Primary Topic
Cardiac Arrhythmias and Treatments
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article
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article

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

Suresh Kumar Sukumaran, Raja J. Selvaraj, Anish Bhargav, Sridhar Balaguru
Indian Pacing and Electrophysiology Journal
Cardiac Arrhythmias and Treatments
article

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

Suresh Kumar Sukumaran, Raja J. Selvaraj, Anish Bhargav, Sridhar Balaguru
article en

Abstract

A 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?

Indian Pacing and Electrophysiology JournalVol. 24(6)
Pondicherry University (IN), Jawaharlal Institute of Post Graduate Medical Education and Research (IN)
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Openalex Percentile: Top 75%
Cardiac Arrhythmias and Treatments
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Conflicting responses with simultaneous atrioventricular pacing. What is the mechanism? — Suresh Kumar Sukumaran, Raja J. Selvaraj, et al. · Indian Pacing and Electrophysiology Journal (2024) | TGRS Research Map | TGRS