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Europace Advance Access originally published online on November 15, 2007
Europace 2008 10(1):110-111; doi:10.1093/europace/eum240
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2007.For permissions please email: journals.permissions@oxfordjournals.org

ELECTROCARDIOGRAPHY

Wide QRS-complex tachycardia with variable VA-conduction: what is the mechanism?

Hildegard Tanner, Takao Sakata and Etienne Delacrétaz*

Swiss Cardiovascular Center Bern, University Hospital, CH-3010 Bern, Switzerland

We describe the case of a 16-year-old woman with a surgically corrected tetralogy of Fallot presenting with recurrent wide-QRS-complex tachycardia. The tachycardia could be induced and terminated with ventricular stimulation only. QRS morphology during sinus rhythm and tachycardia was identical and variable VA-conduction was observed. Mapping of the tachycardia showed that variations of HH intervals preceded VV intervals. Therefore, a mechanism involving re-entry within the bundle branches was suggested. However, detailed mapping showed cranial to caudal depolarization of the His bundle, leading to the diagnosis of atrioventricular node re-entrant tachycardia. The tachycardia was abolished by radiofrequency catheter ablation of the slow AV nodal pathway. We conclude that variable VA conduction can occur in patients with atrioventricular node re-entrant tachycardia. The atrial tissue is not always an integral part of the re-entrant circuit.

Key Words: Wide-QRS-complex tachycardia, Tetralogy of Fallot, Catheter ablation, AV nodal reentry tachycardia

* Corresponding author: Tel: +41 31 632 2111; fax: +41 31 632 1414. E-mail address: etienne.delacretaz{at}insel.ch

Manuscript submitted 3 September 2007. Accepted after revision 8 October 2007.


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