Highlights the importance of accurate electrophysiologic diagnosis in patients with refractory tachycardia, demonstrating successful treatment of nonreentrant SVT with slow pathway ablation.
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Suggests potential role for slow pathway ablation in nonreentrant SVT; leaves open need for prospective validation before broader use.
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.
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Bhatt et al. (2010) studied this question.
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