Key result
Atypical SVT features P waves marching through QRS complexes, driven by dual AV nodal physiology.
Why the study?
Dual AV nodal physiology can alter ventricular response during supraventricular tachycardia and mask Wenckebach conduction manifestations, complicating diagnosis.
Case Report
Dual AV nodal physiology can mask Wenckebach conduction during SVT, leading to the deceptive appearance of a regular narrow QRS tachycardia with P waves marching through QRS complexes.
Answers are grounded in this paper and cite their sources.
Clinicians should consider dual AV nodal shifts when interpreting regular narrow QRS SVT with marching P waves; extends mechanistic insights but leaves open broader prevalence.
Dual AV nodal physiology may substantially alter the ventricular response during supraventricular tachycardia through shifts between fast- and slow-pathway conduction. Under certain conditions, this interaction can mask the expected manifestations of Wenckebach conduction, resulting in the appearance of a relatively regular narrow QRS tachycardia. We present an unusual tachycardia in which P waves appeared to march through the QRS complexes without obvious dropped beats on the surface electrocardiogram.
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Mannoji et al. (2026) conducted a case report in Supraventricular tachycardia. An unusual presentation of supraventricular tachycardia involved P waves marching through the QRS complexes without dropped beats, likely driven by dual AV nodal physiology.
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