This case demonstrates that double ventricular responses to a single atrial depolarization can occur during AV nodal reentrant tachycardia following extrastimulation, expanding on previous observations limited to atrial pacing in sinus rhythm.
May warrant awareness of double ventricular responses in AVNRT; leaves open mechanistic extension beyond sinus rhythm pacing.
In patients with dual atrioventricular (AV) nodal pathways, double ventricular responses to a single atrial depolarization have been shown to occur, but virtually only during atrial pacing in sinus rhythm. We report on a patient with a slow-fast form of AV nodal reentrant tachycardia who exhibited double ventricular responses following extrastimulation during AV nodal reentrant tachycardia. The phenomenon of double ventricular responses during the tachycardia was demonstrated by extrastimulation from the proximal coronary sinus. Retrograde unidirectional block in the slow pathway, and an anterograde effective refractory period that was shorter in the fast pathway than that in the slow pathway, are suggested.
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Suzuki et al. (1994) studied this question.
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