{"id":10898,"date":"2026-06-29T18:43:27","date_gmt":"2026-06-29T18:43:27","guid":{"rendered":"https:\/\/cardiocases.com\/?post_type=ecg_case&#038;p=10898"},"modified":"2026-07-02T11:36:09","modified_gmt":"2026-07-02T11:36:09","slug":"trace-7-18-atypical-atrioventricular-nodal-reentrant-tachycardia","status":"publish","type":"ecg_case","link":"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-7-18-atypical-atrioventricular-nodal-reentrant-tachycardia\/","title":{"rendered":"Trace 7.18: Atypical atrioventricular nodal reentrant tachycardia"},"content":{"rendered":"","protected":false},"featured_media":9791,"template":"","ecg_case_type":[256],"language_ecgcase":[258],"class_list":["post-10898","ecg_case","type-ecg_case","status-publish","has-post-thumbnail","hentry","ecg_case_type-junctional-tachycardia","language_ecgcase-english"],"acf":{"ecg_case_title":"Trace 7.18: Atypical atrioventricular nodal reentrant tachycardia","patient_description":"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","quiz_question":"Regarding this ECG, which answer(s) is(are) true?","quiz_answer_1":"the initial tracing is normal","quiz_answer_2":"the tachycardia begins on a ventricular extrasystole","quiz_answer_3":"the tachycardia QRS complexes are of the left delay type","quiz_answer_4":"the tachycardia QRS complexes are of the right delay type","quiz_answer_5":"the tachycardia is of the long RP' type","correct_answer":["A","B","C","E"],"ecg_image":9791,"ecg_description":"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\u2019 waves in inferior leads and positive in V1) with long RP\u2019 (P\u2019 wave at the peak of the T wave);","ecg_info_box":"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\u2019 interval and negative P\u2019 waves in the inferior leads.","commentary_ecg":"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. This atypical form, known as fast-slow, corresponds to approximately 5% of intranodal reentry induced in the electrophysiology laboratory; the fast nodal pathway is used in the anterograde direction and the slow pathway in the retrograde direction. This type of tachycardia is preferably triggered by a ventricular extrasystole or by rapid ventricular pacing. Contrary to the typical shape, a retrograde conduction jump revealing a nodal duality and a P\u2019 wave located remotely from the QRS complex can be observed on the first tachycardia cycle, the ascent to the atrium being achieved through the slow pathway (blocked retrograde pathway).\r\n\r\nDuring the tachycardia, there is usually:\r\n\r\n1.   narrow QRS complexes even if, as in this patient, the presence of a bundle branch block via a conduction aberration is possible;\r\n2.   a long RP\u2019 interval;\r\n3.   P\u2019 waves most often negative in the inferior leads and positive in V1. The late P\u2019 wave superimposes or follows the T wave of the preceding cycle and can be identified much more easily than in the typical form. The primary atrial depolarization site is located at the base of the Koch triangle or in the first centimeters of the coronary sinus explaining the negative deflection in the inferior leads.\r\n \r\n\r\nThis particular electrocardiographic pattern (narrow QRS tachycardia, 1:1 ratio between atria and ventricles, long RP\u2019 interval and negative P\u2019 waves inferiorly) may sometimes hamper the differential diagnosis with atrial tachycardia or orthodromic tachycardia using a septal accessory pathway with slow retrograde conduction (Coumel tachycardia). The clinical setting (more or less permanent tachycardias for PJRT versus tachycardia episodes with sudden onset and termination) can direct the diagnosis. The recording of the beginning and the end of the tachycardia can also facilitate the diagnosis (atrial tachycardia generally starting on an atrial extrasystole and ending on a ventricular cycle, an atypical intranodal reentry generally beginning on a ventricular extrasystole and being terminated by vagal maneuvers). Electrophysiological study generally provides a definitive answer.","ecg_info_post_answer":"<img class=\"alignnone wp-image-10934 size-large\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/06\/trace-7-18-ecg-en-1024x576.jpg\" alt=\"\" width=\"800\" height=\"450\" \/>\r\n\r\n&nbsp;\r\n\r\n&nbsp;\r\n\r\n<img class=\"alignnone wp-image-10480 size-full\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/04\/trace-7-18-ecg2.png\" alt=\"\" width=\"912\" height=\"638\" \/>\r\n\r\n<strong>Trace description\u00a0<\/strong>\r\n\r\nTachycardia termination after a sino-carotid massage;"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.0 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Trace 7.18: Atypical atrioventricular nodal reentrant tachycardia - Cardiocases<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-7-18-atypical-atrioventricular-nodal-reentrant-tachycardia\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Trace 7.18: Atypical atrioventricular nodal reentrant tachycardia - Cardiocases\" \/>\n<meta property=\"og:url\" content=\"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-7-18-atypical-atrioventricular-nodal-reentrant-tachycardia\/\" \/>\n<meta property=\"og:site_name\" content=\"Cardiocases\" \/>\n<meta property=\"article:modified_time\" content=\"2026-07-02T11:36:09+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-7-18-ecg-e1782935594172.png\" \/>\n\t<meta property=\"og:image:width\" content=\"910\" \/>\n\t<meta property=\"og:image:height\" content=\"632\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/png\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Dur\u00e9e de lecture estim\u00e9e\" \/>\n\t<meta name=\"twitter:data1\" content=\"1 minute\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/cardiocases.com\\\/ecg_case\\\/trace-7-18-atypical-atrioventricular-nodal-reentrant-tachycardia\\\/\",\"url\":\"https:\\\/\\\/cardiocases.com\\\/ecg_case\\\/trace-7-18-atypical-atrioventricular-nodal-reentrant-tachycardia\\\/\",\"name\":\"Trace 7.18: Atypical atrioventricular nodal reentrant tachycardia - Cardiocases\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/cardiocases.com\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/cardiocases.com\\\/ecg_case\\\/trace-7-18-atypical-atrioventricular-nodal-reentrant-tachycardia\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/cardiocases.com\\\/ecg_case\\\/trace-7-18-atypical-atrioventricular-nodal-reentrant-tachycardia\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/cardiocases.com\\\/wp-content\\\/uploads\\\/2026\\\/03\\\/trace-7-18-ecg-e1782935594172.png\",\"datePublished\":\"2026-06-29T18:43:27+00:00\",\"dateModified\":\"2026-07-02T11:36:09+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/cardiocases.com\\\/ecg_case\\\/trace-7-18-atypical-atrioventricular-nodal-reentrant-tachycardia\\\/#breadcrumb\"},\"inLanguage\":\"fr-FR\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/cardiocases.com\\\/ecg_case\\\/trace-7-18-atypical-atrioventricular-nodal-reentrant-tachycardia\\\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"fr-FR\",\"@id\":\"https:\\\/\\\/cardiocases.com\\\/ecg_case\\\/trace-7-18-atypical-atrioventricular-nodal-reentrant-tachycardia\\\/#primaryimage\",\"url\":\"https:\\\/\\\/cardiocases.com\\\/wp-content\\\/uploads\\\/2026\\\/03\\\/trace-7-18-ecg-e1782935594172.png\",\"contentUrl\":\"https:\\\/\\\/cardiocases.com\\\/wp-content\\\/uploads\\\/2026\\\/03\\\/trace-7-18-ecg-e1782935594172.png\",\"width\":910,\"height\":632},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/cardiocases.com\\\/ecg_case\\\/trace-7-18-atypical-atrioventricular-nodal-reentrant-tachycardia\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/cardiocases.com\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Trace 7.18: Atypical atrioventricular nodal reentrant tachycardia\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/cardiocases.com\\\/#website\",\"url\":\"https:\\\/\\\/cardiocases.com\\\/\",\"name\":\"Cardiocases\",\"description\":\"Real cardiac device traces, pacemaker &amp; 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