title: Nonreentrant atrioventricular nodal tachycardia due to triple nodal pathways manifested by radiofrequency ablation at coronary sinus ostium.
abstract: We report a case of complex supraventricular tachycardia manifested by radiofrequency delivery. Initially, the patient presented with orthodromic atrioventricular reentrant tachycardia via a left-sided accessory pathway that was successfully eliminated. Atrial tachycardia originating from coronary sinus ostium was also induced. Radiofrequency delivery at the coronary sinus ostium induced a narrow QRS tachycardia with irregular R-R intervals. A detailed analysis explained that the tachycardia could be a nonreentrant mechanism due to triple atrioventricular nodal pathways: an atrial excitation evokes double ventricular response due to simultaneous activation of the fast and slow pathways, and the next one activates ventricle through the intermediate pathway.
authors.affiliation: Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan. yokoshh@med.hokudai.ac.jp
authors.forename: Hisashi
authors.initials: H
authors.lastname: Yokoshiki
authors.forename: Koji
authors.initials: K
authors.lastname: Sasaki
authors.forename: Junichi
authors.initials: J
authors.lastname: Shimokawa
authors.forename: Masayuki
authors.initials: M
authors.lastname: Sakurai
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tsutsui
mesh_terms: D000328:Adult; D017115:Catheter Ablation / Q000009:adverse effects*; D003331:Coronary Vessels / Q000601:surgery*; D004562:Electrocardiography / Q000379:methods; D005260:Female; D006329:Heart Conduction System / Q000002:abnormalities*; D006801:Humans; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000175:diagnosis* / Q000209:etiology*