title: Paradoxical responses to pacing maneuvers differentiating atrioventricular node reentrant tachycardia and junctional tachycardia.
abstract: A 40-year-old female presented at our hospital because of heart palpitations. During an electrophysiological study, atrioventricular (AV) conduction showed dual AV nodal physiology. Three types of supraventricular tachycardia (SVT) were induced. The initiation of SVT was reproducibility dependent on a critical A-H interval prolongation. An early premature atrial contraction during SVT repeatedly advanced the immediate His potential with termination of the tachycardia, indicating AV node reentrant tachycardia (AVNRT). However, after atrial overdrive pacing during SVT without termination of the tachycardia, the first return electrogram resulted in an AHHA response, consistent with junctional tachycardia. The mechanism of paradoxical responses to pacing maneuvers differentiating AVNRT and junctional tachycardia was discussed.
authors.affiliation: Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan. tokudam@gmail.com.
authors.forename: Michifumi
authors.initials: M
authors.lastname: Tokuda
authors.affiliation: Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan.
authors.forename: Teiichi
authors.initials: T
authors.lastname: Yamane
authors.affiliation: Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan.
authors.forename: Seiichiro
authors.initials: S
authors.lastname: Matsuo
authors.affiliation: Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Tokutake
authors.affiliation: Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Yokoyama
authors.affiliation: Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan.
authors.forename: Mika
authors.initials: M
authors.lastname: Hioki
authors.affiliation: Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan.
authors.forename: Ryohsuke
authors.initials: R
authors.lastname: Narui
authors.affiliation: Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan.
authors.forename: Shin-Ichi
authors.initials: S
authors.lastname: Tanigawa
authors.affiliation: Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan.
authors.forename: Seigo
authors.initials: S
authors.lastname: Yamashita
authors.affiliation: Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Inada
authors.affiliation: Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan.
authors.forename: Michihiro
authors.initials: M
authors.lastname: Yoshimura
mesh_terms: D000200:Action Potentials; D000328:Adult; D002304:Cardiac Pacing, Artificial; D017115:Catheter Ablation; D003937:Diagnosis, Differential; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology* / Q000601:surgery; D006339:Heart Rate; D006801:Humans; D011237:Predictive Value of Tests; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D013613:Tachycardia, Ectopic Junctional / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D016896:Treatment Outcome
keywords: Atrioventricular node reentrant tachycardia; Catheter ablation; Junctional tachycardia; Paroxysmal supraventricular tachycardia