open access

Vol 64, No 6 (2006)
Other
Published online: 2006-06-27
Submitted: 2012-12-28
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Invasive electrophysiology
QRS and cycle length alternans during atrioventricular nodal reentry tachycardia: case report

Aleksander Bardyszewski, Łukasz Szumowski, Jacek Kuśnierz, Wioletta Cioch-Domarska, Robert J. Gil, Franciszek Walczak
Kardiol Pol 2006;64(6):649-651.

open access

Vol 64, No 6 (2006)
Other
Published online: 2006-06-27
Submitted: 2012-12-28

Abstract

A 23-year old man with paroxysmal, poorly tolerated and spontaneously terminating palpitations, was referred to our department for electrophysiological study. Burst pacing from high right atrium using a cycle length of 350 ms induced a slow-fast atrioventricular nodal reentry tachycardia. We excluded the presence of accessory atrioventricular tracts. During tachycardia a constant alternans of QRS morphology and cycle length was observed. The cycle length alternans could be due to the presence of three nodal pathways and activation circulating in a figure-of-eight pattern using alternatively two slow pathways as the antegrade arm of the reentry loop. The alternans could also originate from altering decremental properties of a single slow pathway that changed its conduction properties with relation to the length of the preceding cycle. The QRS alternans occurred both during burst pacing and tachycardia. As it was related to the rate and the changing cycle length, we concluded that it could reflect aberration in intraventricular conduction.

Abstract

A 23-year old man with paroxysmal, poorly tolerated and spontaneously terminating palpitations, was referred to our department for electrophysiological study. Burst pacing from high right atrium using a cycle length of 350 ms induced a slow-fast atrioventricular nodal reentry tachycardia. We excluded the presence of accessory atrioventricular tracts. During tachycardia a constant alternans of QRS morphology and cycle length was observed. The cycle length alternans could be due to the presence of three nodal pathways and activation circulating in a figure-of-eight pattern using alternatively two slow pathways as the antegrade arm of the reentry loop. The alternans could also originate from altering decremental properties of a single slow pathway that changed its conduction properties with relation to the length of the preceding cycle. The QRS alternans occurred both during burst pacing and tachycardia. As it was related to the rate and the changing cycle length, we concluded that it could reflect aberration in intraventricular conduction.
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Keywords

alternans; nodal reentry; tachycardia; aberration

About this article
Title

Invasive electrophysiology
QRS and cycle length alternans during atrioventricular nodal reentry tachycardia: case report

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 64, No 6 (2006)

Pages

649-651

Published online

2006-06-27

Bibliographic record

Kardiol Pol 2006;64(6):649-651.

Keywords

alternans
nodal reentry
tachycardia
aberration

Authors

Aleksander Bardyszewski
Łukasz Szumowski
Jacek Kuśnierz
Wioletta Cioch-Domarska
Robert J. Gil
Franciszek Walczak

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