Key result
Electrophysiologic testing in a patient with a biventricular ICD and broad complex tachycardia revealed a 1:1 atrioventricular relationship, but atrial pacing suggested atrial dissociation.
Case Report (n=1)
This case highlights the diagnostic challenge of a broad complex tachycardia where pacing maneuvers yield conflicting information regarding atrial involvement.
Conflicting pacing results in broad complex tachycardia with biventricular ICDs warrant cautious interpretation; this case leaves open the diagnostic role of atrial dissociation.
A patient with a biventricular implantable cardioverter defibrillator for heart failure had a recurrent broad complex tachycardia and underwent electrophysiologic testing. The tachycardia was induced only with ventricular pacing. There was a 1:1 atrioventricular relationship with simultaneous atrial and ventricular activation. However, atrial pacing during tachycardia suggested atrial dissociation from the circuit. The findings, potential mechanisms, and treatment are discussed.
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Hunter et al. (2009) conducted a case report in Recurrent broad complex tachycardia (n=1). Electrophysiologic testing and pacing manoeuvres was evaluated on Findings from pacing manoeuvres during tachycardia. Electrophysiologic testing in a patient with a biventricular ICD and broad complex tachycardia revealed a 1:1 atrioventricular relationship, but atrial pacing suggested atrial dissociation.
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