title: Nonreentrant supraventricular tachycardia misdiagnosed as inappropriate sinus tachycardia.
abstract: We report a case of a woman with incessant palpitations initially misdiagnosed as inappropriate sinus tachycardia that proved refractory to β-blockers. At the time of electrophysiologic testing, a sustained narrow-complex tachycardia with a 1:2 atrioventricular relationship was repeatedly initiated by a posterior fascicle depolarization induced by means of a timed ventricular extrastimulus. The tachycardia was repeatedly terminated with a timed atrial extrastimulus, which excluded junctional bigeminy and confirmed the diagnosis of nonreentrant supraventricular tachycardia. Catheter ablation of the slow pathway eliminated dual-pathway conduction and tachycardia.
authors.affiliation: Clinical Cardiac Electrophysiology, Boston University School Medical Center, Boston, Massachusetts 02118, USA.
authors.forename: Advay G
authors.initials: AG
authors.lastname: Bhatt
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Monahan
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D017115:Catheter Ablation; D003951:Diagnostic Errors; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D008875:Middle Aged; D013616:Tachycardia, Sinus / Q000175:diagnosis* / Q000503:physiopathology; D013617:Tachycardia, Supraventricular / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists