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Europace Advance Access published online on January 10, 2006

Europace, doi:10.1093/europace/euj033
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© The European Society of Cardiology 2006. All rights reserved
Received March 25, 2005
Accepted November 9, 2005


Case Report

Atrioventricular nodal re-entrant tachycardia with QRS voltage and cycle length alternation and aberrant conduction due to two distinct antegrade slow pathways

Basri Amasyali 1 *, Sedat Kose 1, and Turgay Çelik 1

1 Department of Cardiology, Gulhane Military Medical Academy, 06018 Etlik, Ankara, Turkey

* To whom correspondence should be addressed.
Basri Amasyali, E-mail: dramasyali{at}yahoo.com


   Abstract

QRS voltage and cycle length alternation can be seen during supraventricular re-entrant tachycardias, especially in atrioventricular (AV) re-entrant tachycardia. We present a case of a 20-year-old man, in which AV nodal re-entrant tachycardia (AVNRT) shows alternation of QRS voltage and cycle length, as well as right bundle branch block aberration due to a re-entrant circuit using two distinct, beat-to-beat alternating slow AV nodal pathways antegradely and a single fast pathway retrogradely. Although more than one antegrade slow pathway exists, creation of a single lesion at the right posterior atrial septum using the conventional right-sided approach successfully eliminated AVNRT.

Keywords: Atrioventricular nodal re-entrant tachycardia; Cycle length alternation; QRS alternation; Right bundle branch block.
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