Key result
Slow-pathway ablation successfully eliminates typical AVNRT with rate-dependent aberrancy.
Why the study?
Regular wide-complex tachycardia often prompts concern for ventricular tachycardia, yet supraventricular tachycardia with aberrancy is a frequent mimic that requires differentiation.
Case Report (n=1)
When an alternating narrow- and wide-complex tachycardia occurs without a change in cycle length, clinicians should strongly suspect a single supraventricular mechanism (like AVNRT) with rate-dependent aberrancy rather than ventricular tachycardia.
Supports ablation feasibility in AVNRT with rate-dependent aberrancy mimicking VT; leaves open generalizability pending larger studies.
BACKGROUND: Regular wide-complex tachycardia often prompts concern for ventricular tachycardia, yet supraventricular tachycardia with aberrancy is a frequent mimic. CASE SUMMARY: A 36-year-old male presented with palpitations, dizziness, and presyncope after ambulatory monitoring documented tachycardia >200 beats/min. Telemetry showed recurrent regular tachycardia with alternating narrow and wide QRS morphologies at a similar cycle length. Vagal maneuvers, adenosine, and diltiazem transiently slowed/terminated the rhythm, but it recurred, necessitating cardioversion. Electrophysiology study induced typical atrioventricular nodal re-entrant tachycardia with rate-dependent aberrancy; slow-pathway ablation rendered the tachycardia noninducible. DISCUSSION: Unchanged cycle length during narrow-to-wide transitions supports a single supraventricular tachycardia mechanism with a functional bundle branch block. TAKE-HOME MESSAGE: When QRS morphology alternates without cycle-length change, suspect supraventricular tachycardia with aberrancy and confirm with electrophysiology testing.
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Madishetty et al. (2026) conducted a case report in AVNRT with intermittent aberrancy (n=1). Slow-pathway ablation was evaluated on Tachycardia inducibility post-ablation. Slow-pathway ablation successfully rendered the recurrent typical atrioventricular nodal re-entrant tachycardia with rate-dependent aberrancy noninducible.
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