Provided by Cognitive Sciences ePrint Archive
I ιdian
RACINGand ELECTROPHYSIOLOGY www.ipej.org 66
Journal
Case Report
Multiple Arrhythmogenic Substrate for Tachycardia in a
Patient with Frequent Palpitations
Majid Haghjoo, MD, Arash Arya, MD, Mohammadreza Dehghani, MD, Zahra Emkanjoo, MD,
Amirfarjam Fazelifar, MD, MohammadAli Sadr-Ameli, MD.
Department of Pacemaker and Electrophysiology, Shahid Rajaie Cardiovascular Center, School
of Medicine, Iran University of Medical Sciences, Tehran, Iran
Address for correspondence: Majid Haghjoo M.D, Department of Pacemaker and
Electrophysiology, Shahid Rajaie Cardiovascular Center , Mellat Park, Vali-E-Asr Avenue,
Tehran, Iran. P.O. Box: 15745-1341. E-mail: [email protected]
Abstract
We report a 26-year-old woman with frequent episodes of palpitation and dizziness.
Resting electrocardiography showed no evidence of ventricular preexcitation. During
electrophysiologic study, a concealed right posteroseptal accessory pathway was detected and
orthodromic atrioventricular reentrant tachycardia incorporating this pathway as a retrograde
limb was reproducibly induced. After successful ablation of right posteroseptal accessory
pathway, another tachycardia was induced using a concealed right posterolateral accessory
pathway in tachycardia circuit. After loss of retrograde conduction of second accessory pathway
with radiofrequency ablation, dual atrioventricular nodal physiology was detected and typical
atrioventricular nodal reentrant tachycardia was repeatedly induced. Slow pathway ablation was
done successfully. Finally sustained self-terminating atrial tachycardia was induced under
isoproterenol infusion but no attempt was made for ablation. During 8-month follow-up, no
recurrence of symptoms attributable to tachycardia was observed.
Keywords: atrioventricular nodal reentrant tachycardia; atrioventricular reentrant tachycardia;
atrial tachycardia; accessory pathway; catheter ablation
Introduction
Several reports demonstrated the existence of double tachycardia such as atrioventricular
reentrant tachycardia (AVRT) and atrioventricular nodal reentrant tachycardia (AVNRT)1,2,3, or
AVNRT and atrial tachycardia (AT)4, but coexistence of four different type of supraventricular
tachycardia (SVT) in the same patient rarely reported. We report radiofrequency (RF) catheter
ablation of two different AVRTs, and typical AVNRT in a patient with four different SVT.
Case report
A 26-year-old woman, with no evidence of structural heart disease, was referred to our
center for evaluation of palpitation and dizziness. Despite frequent occurrence of palpitation, she
Indian Pacing and Electrophysiology Journal (ISSN 0972-6292), 5(1): 66-70 (2005)