Nonreentrant Supraventricular Tachycardia Misdiagnosed as Inappropriate Sinus Tachycardia

Abstract

We report a case of a woman with incessant palpitations initially misdiagnosed as inappropriate sinus tachycardia that proved refractory to β-blockers. At the time of electrophysiologic testing, a sustained narrow-complex tachycardia with a 1:2 atrioventricular relationship was repeatedly initiated by a posterior fascicle depolarization induced by means of a timed ventricular extrastimulus. The tachycardia was repeatedly terminated with a timed atrial extrastimulus, which excluded junctional bigeminy and confirmed the diagnosis of nonreentrant supraventricular tachycardia. Catheter ablation of the slow pathway eliminated dual-pathway conduction and tachycardia.

Dual Atrioventricular Nodal Nonreentrant Tachycardia: A Systematic Review

“…One citation was suggested by a reviewer during the manuscript review process. Thus, 48 nonduplicate citations were eligible for inclusion 5–52 . Two articles described the same case so only the English language article was used 9,49 .…”

“…Atropine and isoproterenol, which suppress DAVNNT, are expected to exacerbate triggered junctional activity and have been suggested as a means to differentiate the two 10 . In the electrophysiology laboratory, termination of the tachycardia with a timed atrial extrastimuli that does not capture the His bundle has been suggested as a method to exclude junctional bigeminy 46 . Nevertheless, none of these features have been systematically evaluated.…”

Dual AV Nodal Nonreentrant Tachycardia Resulting in Inappropriate ICD Therapy in a Patient with Cardiac Sarcoidosis

“…[2] The authors have previously described a patient with DAVNNT who was misdiagnosed as having inappropriate sinus tachycardia. [3] The differential diagnosis for a narrow complex tachycardia with a P:R ratio of 1:2 includes (1) atrial bigeminy with a low voltage P-wave masked by the preceding T-wave, (2) junctional bigeminy, and (3) atrioventricular nodal re-entrant tachycardia (AVNRT) with 2:1 retrograde block. [4] During electrophysiologic testing, the differential diagnosis includes junctional extrasytole and junction parasystole.…”

“…[2] The authors have demonstrated that atrial extrastimuli which terminate tachycardia without His capture effectively rule out junctional bigeminy. [3] Ultimately, definitive proof of DAVNNT is disappearance of the electrophysiologic manifestations of 1:2 AV conduction following slow pathway ablation. [2]…”

Wide Complex Tachycardia Causing Congestive Heart Failure

“…Several cases of double firing or nonreentrant AV nodal tachycardia have been reported, [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] including a case of tachycardia-induced cardiomyopathy. 11 However, our case is unique due to its presentation as a wide complex tachycardia and variable QRS morphologies secondary to possible gap physiology.…”