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Patient
24-year-old man with paroxysmal tachycardias, with abrupt onset and abrupt termination, lasting a few minutes; recording of the onset of a palpitation episode
Trace
The initial tracing is normal (sinus, normal PR, narrow QRS); ventricular extrasystole couplet; first tachycardia cycle with narrow QRS; wide QRS tachycardia (left delay) with probable retrograde atrial conduction (negative P' waves in inferior leads and positive in V1) with long RP' (P' wave at the peak of the T wave);
Trace
Tachycardia termination after a sino-carotid massage;
Exergue
In an atypical atrio-ventricular nodal reentrant tachycardia (fast-slow form), the circuit is reversed relative to the typical form thus explaining the electrocardiographic pattern: narrow QRS tachycardia (but possible conduction aberration), long RP' interval and negative P' waves in the inferior leads.
Electrophysiological study confirmed that this patient presented episodes of atypical atrio-ventricular nodal reentrant tachycardia with a conduction aberration of the left bundle branch block type.