A case of typical and atypical atrioventricular nodal reentrant tachycardia with a bystander nodoventricular pathway diagnosed based on the findings during early ventricular premature contractions

Figures

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  Figure 1. A: Electrocardiogram during sinus rhythm (after the supraventricular tachycardia [SVT] termination). B: Electrocardiogram during clinical SVT.

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  Figure 2. A: His-refractory ventricular premature contraction (VPC) reset supraventricular tachycardia (SVT)-1 with the delay of subsequent His and next atrium (underlined H and A). B: The reset phenomenon disappeared by “earlier” His-refractory VPC. C: SVT-1 was terminated by VPC earlier than His with atrial advancement (circle). A = atrium; d = distal; H = His; p = proximal; S = stimulation; V = ventricle.

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  Figure 3. A: Supraventricular tachycardia (SVT)-2 was terminated without atrial capture by His-refractory ventricular premature contraction (VPC). B: SVT-2 was reset during the QRS fusion period (by fifth ventricular stimulus). Twelve-lead electrocardiogram during this period is shown in Supplementary Figure 3. C: Very early VPC advanced SVT-2 without termination. A = atrium; d = distal; H = His; p = proximal; S = stimulation; V = ventricle.

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  Supplementary Figure 1. Entrainment pacing of SVT-1 by VOP from RVA. Corrected PPI was calculated to be 140 ms ([672 -520] – [450-438] = 140). A, atrium; d, distal; H, His; p, proximal; PPI, post pacing interval; S, stimulation; TCL, tachycardia cycle length; V, ventricle

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  Supplementary Figure 2. (A) The speculated ladder diagrams corresponds to Figure 2A. The Blue dotted line indicates the conduction delay within the slow pathway. (B) corresponds to Figure 2B and (C) corresponds to Figure 2C. Dotted horizontal lines indicate the connection site of NF/NV pathway to the SP (also in Supplementary Figure 4). AVN, atrioventricular node; RBB, right bundle branch; FP, fast pathway; NF/NV, nodofascicular/nodoventricular pathway; SP, slow pathway

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  Supplementary Figure 3. 12-lead electrocardiogram during the QRS fusion period of VOP for SVT-2. S, stimulation

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  Supplementary Figure 4. (A) The speculated ladder diagram corresponds to Figure 3A. (B) corresponds to Figure 3C. AVN, atrioventricular node; RBB, right bundle branch; FP, fast pathway; NF/NV, nodofascicular/nodoventricular pathway; SP, slow pathway; VPC, ventricular premature contraction

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  Supplementary Figure 5. The comparison of atrial sequences before and after the reset of tachycardias. (A) SVT-1 reset by His-refractory VPC. (B) SVT-2 reset during the fusion period of VOP. A, atrium; H, His; S, stimulation; V, ventricle