Double ventricular response in dual AV nodal pathways mimicking interpolated premature beat

Abstract

Double ventricular response in dual atrioventricular (AV) nodal pathways can result in nonreentrant supraventricular tachycardia. Since this condition was first described in 1979, around 20 cases have been reported. Here, we present the case of a patient with a confirmed diagnosis of double ventricular response in dual AV nodal pathways resembling an interpolated premature beat who underwent successful radiofrequency ablation of the slow pathway.

Validation of dual atrioventricular nodal physiology in dual atrioventricular nodal non‐reentrant tachycardia via adenosine triphosphate injection during atrial pacing: A novel insight into the role of leftward inferior extension

“…Historically, literature has identified the posteroseptal right atrium as the most effective ablation site for DAVNNT, mirroring the typical SP. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] Notably, none of the previous studies [13][14][15] In this particular instance, traditional SP, encompassing RIE, did not resurface. We deduced this considering that both RF ablation and cryoablation within the right atrial septum did not impact the DAVNNT, while RF ablation at the left atrial septum successfully neutralized it.…”

“…DAVNNT, a rare arrhythmia, is characterized by double antegrade AV nodal conduction. Historically, literature has identified the posteroseptal right atrium as the most effective ablation site for DAVNNT, mirroring the typical SP 1–19 . Notably, none of the previous studies have documented successful DAVNNT treatment via left atrial ablation.…”

A case of heart failure complicated with double ventricular response triggered by beta blocker

“…Double ventricular response is difficult to diagnose and is often mistaken for other supraventricular arrhythmias, such as atrial premature complex or atrial fibrillation. 1,2 The following conditions are required for the presence of a double ventricular response 3 : (1) conduction through the slow pathway must be significantly delayed; (2) the effective refractory periods of the AV node distal common pathway and His-Purkinje system must be shorter than the difference between the conduction times of the fast and slow pathways; (3) retrograde ventriculoatrial conduction through the slow…”

“…Double ventricular response is difficult to diagnose and is often mistaken for other supraventricular arrhythmias, such as atrial premature complex or atrial fibrillation. 1 , 2 The following conditions are required for the presence of a double ventricular response 3 : (1) conduction through the slow pathway must be significantly delayed; (2) the effective refractory periods of the AV node distal common pathway and His-Purkinje system must be shorter than the difference between the conduction times of the fast and slow pathways; (3) retrograde ventriculoatrial conduction through the slow pathway must be poor or absent; and (4) the refractory period of the fast pathway must be relatively short. In summary, double ventricular response would occur only when the complex conditions are met by combinations of the following factors: the conduction velocities of fast and slow pathways, the refractory period of fast and slow pathways, the refractory period of the His-Purkinje system, and ventricular muscle.…”

Frequent inappropriate implantable cardioverter defibrillator therapy was determined to be dual atrioventricular nodal non-reentrant tachycardia

“…Because it is not widely known, DAVNNRT may be diagnosed as atrial fibrillation, atrial premature beats, or other SVTs, especially since dual AV nodal conduction may be intermittent. [ 7 , 8 ] Bigeminal junctional ectopy could be another arrhythmogenic mechanism for this, but it usually shows more irregular variations in the coupling interval with the previous sinus beat. [ 9 ] DAVNNRT has a fixed H-V interval and a slight variation in the R1R2 interval.…”