An uncommon case of dual ventricular response in dual atrioventricular nodal non-reentrant tachycardia

Figures

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  Figure 1. Each QRS complex was followed by 1 P-wave. After an interval, the P-wave captured ventricular and the resulting narrow QRS complex tachycardia. P = p wave, P? = may be p wave, R = QRS complex.

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  Figure 2. Twelve-channel surface ECG revealed that each p-wave was followed by 2 narrow QRS-complexes resulting in narrow QRS complex tachycardia. Ladder diagram showing each atrial impulse that evoked a double ventricular response through fast and slow pathways. ECG = electrocardiogram, FP = fast pathway, H1 = His 1, H2 = His 2, Q1 = QRS complex 1, Q2 = QRS complex 2, SP = slow pathway.

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  Figure 3. Excitement of His is earliest and excitement order of coronary sinus from the nearest point to the most distant point, which demonstrated that the impulse originated from the sinus node. The excitement for the right ventricular apex was earliest, which was followed by a confirmation of the normal ventricular excited order. CS = coronary sinus, His p = His bundle proximal, His d = His bundle distal, Rva = right ventricular.

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  Figure 4. DAVNNT in the form of simultaneous atrioventricular nodal conduction through fast and slow pathways in a 1:2 pattern as revealed by a characteristic A–H1–V1–H2–V2 sequence. DAVNNT = dual atrioventricular nodal non-reentrant tachycardia.