Wide QRS-complex tachycardia with variable VA-conduction: what is the mechanism?

Tanner, Hildegard; Sakata, Takao; Delacrétaz, Etienne (2008). Wide QRS-complex tachycardia with variable VA-conduction: what is the mechanism? Europace, 10(1), pp. 110-1. Oxford: Oxford University Press 10.1093/europace/eum240

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We describe the case of a 16-year-old woman with a surgically corrected tetralogy of Fallot presenting with recurrent wide-QRS-complex tachycardia. The tachycardia could be induced and terminated with ventricular stimulation only. QRS morphology during sinus rhythm and tachycardia was identical and variable VA-conduction was observed. Mapping of the tachycardia showed that variations of HH intervals preceded VV intervals. Therefore, a mechanism involving re-entry within the bundle branches was suggested. However, detailed mapping showed cranial to caudal depolarization of the His bundle, leading to the diagnosis of atrioventricular node re-entrant tachycardia. The tachycardia was abolished by radiofrequency catheter ablation of the slow AV nodal pathway. We conclude that variable VA conduction can occur in patients with atrioventricular node re-entrant tachycardia. The atrial tissue is not always an integral part of the re-entrant circuit.

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