Concealed antegrade penetration of the atrio-ventricular node.
We present a patient with paroxysmal, non-sustained atrial tachycardia (AT) on routine surveillance 24-hour Holter post pulmonary vein isolation (PVI). Several asymptomatic ventricular pauses are noted to follow each burst of AT. We postulate that these pauses are due to the resultant concealed penetration of the atrio-ventricular node (AVN) in combination with sino-atrial node overdrive suppression. Recognition of this physiological phenomenon may help avoid unnecessary intervention arising from Holter recording misinterpretation.
Diez
Juan Cruz Lopez
JC
Michael
Kevin A
KA
Rocchinotti
Monica
M
Shaw
Cathy
C
Redfearn
Damian P
DP
Simpson
Christopher S
CS
Baranchuk
Adrian
A
D000368:Aged; D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects*; D015716:Electrocardiography, Ambulatory; D006329:Heart Conduction System / Q000503:physiopathology; D006801:Humans; D008297:Male; D011667:Pulmonary Veins / Q000601:surgery*; D013612:Tachycardia, Ectopic Atrial / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology