A Concealed Typical AVNRT : U Wave Contribution in Simulating Long RP Supraventricular Tachycardia

Figures

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  FIGURE 1. The 12‐lead electrocardiogram (ECG): During tachycardia, the ECG shows a regular narrow QRS tachycardia at 130 bpm with an apparently long RP interval; the red arrow indicates a positive P wave after the QRS complex, which disappears in sinus rhythm (indicated by blue arrow) (A); The red box highlights the U wave immediately following the T wave in tachycardia (A) and sinus rhythm (B).

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  FIGURE 2. The 24 h‐Holter ECG monitoring; The red box indicates the additional positive deflection after the T wave, resembling a U wave that mimics a long RP interval.

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  FIGURE 3. The electrophysiological study performed during tachycardia (A) and in sinus rhythm (B) demonstrated a short VA interval (37 ms) and an H–A–V activation sequence during tachycardia (A), findings consistent with typical slow–fast atrioventricular nodal reentry.

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  FIGURE 4. The right atrial and coronary sinus 3D activation of the tachycardia map in the left lateral (A) and left anterior oblique incidence (B) shows first activation of the right atrium in the superior septal aspect, in the vicinity of the His Bundle (yellow dots), which is consistent with the fast pathway exit point.