Key result
Early ventricular extrastimulus caused paradoxical delay of the subsequent atrial response and terminated tachycardia, providing a specific sign to exclude atrial reentry.
Case Report (n=1)
Paradoxical delay of atrial response following early ventricular extrastimulus is a specific sign to exclude atrial reentry in narrow QRS tachycardia.
May aid exclusion of atrial reentry in narrow QRS tachycardia; single case report leaves validation open.
Narrow QRS tachycardia with atrial activation occurring before ventricular activation was induced in a 34-year-old woman with dilated cardiomyopathy. During tachycardia late ventricular extrastimulus delivered when His bundle was refractory failed to reset the tachycardia while early ventricular extrastimulus caused paradoxical delay of the subsequent atrial response and terminated the tachycardia with a QRS not being followed by an atrial response. This is a rare but specific sign for excluding atrial reentry as the mechanism of tachycardia when P wave or atrial activation is registered before QRS response.
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Hirai et al. (2011) conducted a case report in Narrow QRS tachycardia and dilated cardiomyopathy (n=1). Ventricular extrastimulus was evaluated on Response to ventricular extrastimulus during tachycardia. Early ventricular extrastimulus caused paradoxical delay of the subsequent atrial response and terminated tachycardia, providing a specific sign to exclude atrial reentry.
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