Key result
Radiofrequency ablation of the slow pathway successfully terminated dual atrioventricular nodal non-reentrant tachycardia and prevented further inappropriate ICD therapy.
Why the study?
Dual atrioventricular node non-reentrant tachycardia (DAVNNRT) is a rare arrhythmia that is easily misdiagnosed as atrial fibrillation and often identified as VT by ICD SVT-VT discriminators.
Case Report (n=1)
No
Dual atrioventricular node non-reentrant tachycardia (DAVNNRT) should be considered as a potential cause of inappropriate ICD therapy and can be effectively managed with slow pathway ablation.
Supports considering DAVNNRT in unexplained inappropriate ICD therapy; single case leaves open need for confirmatory studies.
RATIONALE: Dual atrioventricular node non-reentrant tachycardia (DAVNNRT) is a rare arrhythmia. We present a case of inappropriate implantable cardioverter defibrillator (ICD) therapy caused by DAVNNRT. DAVNNRT is easily misdiagnosed as atrial fibrillation and is often identified as ventricular tachycardia (VT) by the supraventricular tachycardia-ventricular tachycardia (SVT-VT) discriminator of the ICD. PATIENT CONCERNS: A 73-year-old man with ischemic heart disease (IHD) presented with palpitations accompanied by dyspnea and syncope. Frequent multifocal premature ventricular beats and non-sustained ventricular tachycardia were observed on ambulatory electrocardiography. The left ventricular ejection fraction decreased to 32%. DIAGNOSIS: He was diagnosed with IHD, heart failure with reduced ejection fraction (HFrEF), and VT. INTERVENTIONS: : Initially, the patient received a single-chamber ICD implantation for secondary prevention of sudden death. He then suffered from inappropriate anti-tachycardia pacing (ATP)/shock therapy many times after the procedure. DAVNNRT was confirmed in an electrophysiology study (EPS), and radiofrequency ablation of the slow pathway successfully terminated this tachycardia. OUTCOMES: No episode of inappropriate ICD therapy or tachycardia occurred during the follow-up. LESSONS: In conclusion, it is essential to have a full understanding of DAVNNRT and eliminate slow pathways for patients with DAVNNRT and be prepared to implant an ICD.
No takes yet. Share an insight, caveat, or question.
Ma et al. (2021) conducted a case report in Dual atrioventricular node non-reentrant tachycardia (DAVNNRT) causing inappropriate ICD therapy (n=1). Radiofrequency ablation of the slow pathway was evaluated on Termination of tachycardia and prevention of inappropriate ICD therapy. Radiofrequency ablation of the slow pathway successfully terminated dual atrioventricular nodal non-reentrant tachycardia and prevented further inappropriate ICD therapy.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: