Challenges in diagnostic and catheter ablation of long RP supraventricular tachycardia with eccentric activation and decremental properties: a case report

This case illustrates the diagnostic complexity and management challenges of long RP supraventricular tachycardia, particularly in distinguishing atypical atrioventricular nodal reentrant tachycardia from permanent junctional reciprocating tachycardia. When initial ablation does not achieve full arrhythmia control, a stepwise strategy involving detailed electrophysiological evaluation, cautious ablation, and advanced mapping may be required to guide definitive therapy.