title: Unusual Wenckebach phenomenon due to an atrial tachycardia arising from the apex of Koch's triangle in the presence of dual AV nodal physiology.
abstract: A case of a patient with narrow QRS tachycardia and without structural heart disease is presented. The electrophysiologic study revealed an atrial tachycardia in the presence of dual atrioventricular (AV) nodal physiology and AV block at suprahisian level, the latter two leading to an unusual Wenckebach periodicity. The entire septal area was mapped as was the coronary sinus (CS) os and the earliest atrial activation was found at the apex of Koch's triangle in close vicinity to the His bundle (HB). Cryomapping at that point reproducibly terminated the tachycardia without impairing AV conduction. Cryoablation rendered the tachycardia non-inducible. Discontinuous AV conduction persisted but AV nodal reentrant tachycardia (AVNRT) was not inducible. Six months later the patient is arrhythmia-free.
authors.affiliation: Gottsegen György Hungarian Institute of Cardiology, Haller utca 29, H-1096, Budapest, Hungary. t.shalganov@gmail.com
authors.forename: Tchavdar Nikolov
authors.initials: TN
authors.lastname: Shalganov
authors.forename: Dóra
authors.initials: D
authors.lastname: Paprika
authors.forename: Csaba
authors.initials: C
authors.lastname: Földesi
authors.forename: Tamás
authors.initials: T
authors.lastname: Szili-Török
mesh_terms: D000328:Adult; D002037:Bundle-Branch Block / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D003452:Cryosurgery / Q000379:methods*; D005260:Female; D006329:Heart Conduction System / Q000002:abnormalities; D006801:Humans; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D013612:Tachycardia, Ectopic Atrial / Q000150:complications* / Q000175:diagnosis / Q000628:therapy*; D016896:Treatment Outcome