Wide QRS-complex tachycardia with variable VA-conduction: what is the mechanism?

Europace. 2008 Jan;10(1):110-1. doi: 10.1093/europace/eum240. Epub 2007 Nov 15.

Abstract

We describe the case of a 16-year-old woman with a surgically corrected tetralogy of Fallot presenting with recurrent wide-QRS-complex tachycardia. The tachycardia could be induced and terminated with ventricular stimulation only. QRS morphology during sinus rhythm and tachycardia was identical and variable VA-conduction was observed. Mapping of the tachycardia showed that variations of HH intervals preceded VV intervals. Therefore, a mechanism involving re-entry within the bundle branches was suggested. However, detailed mapping showed cranial to caudal depolarization of the His bundle, leading to the diagnosis of atrioventricular node re-entrant tachycardia. The tachycardia was abolished by radiofrequency catheter ablation of the slow AV nodal pathway. We conclude that variable VA conduction can occur in patients with atrioventricular node re-entrant tachycardia. The atrial tissue is not always an integral part of the re-entrant circuit.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Atrioventricular Node / surgery
  • Bundle of His / physiopathology
  • Catheter Ablation
  • Electrocardiography*
  • Female
  • Heart Conduction System / physiopathology*
  • Humans
  • Tachycardia, Atrioventricular Nodal Reentry / physiopathology*
  • Tachycardia, Atrioventricular Nodal Reentry / surgery