Publish in this journal
Journal Information
Vol. 65. Issue 7.
Pages 668 (July 2012)
Share
Share
Download PDF
More article options
Vol. 65. Issue 7.
Pages 668 (July 2012)
DOI: 10.1016/j.rec.2010.11.021
Full text access
Incessant Double Ventricular Response and Paroxysmal Atrial Fibrillation
Doble respuesta nodal incesante y fibrilación auricular paroxística
Visits
...
Moisés Rodríguez-Mañeroa,
Corresponding author
mrodrig3@hotmail.com

Corresponding author: mrodrig3@hotmail.com
, Alfonso Macías Gallegoa, Ignacio García Bolaoa
a Departamento de Cardiología, Unidad de Arritmias, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
This item has received
...
Visits
(Daily data update)
Article information
Full Text
Download PDF
Statistics
Figures (3)
Show moreShow less
Full Text

Atrial fibrillation can be triggered by rapid atrial rhythms, including intranodal tachycardia. We present the recordings of a male patient with paroxysmal atrial fibrillation referred for pulmonary vein ablation following failure of various antiarrhythmic drug treatments (bisoprolol, flecainide, and amiodarone). The initial study showed two QRS complexes with a single p wave. A double nodal pathway was suspected and later confirmed, which led to a change in the therapeutic strategy. This phenomenon is an electrophysiological manifestation of the double nodal pathway, but it is an uncommon finding because detection requires a large difference in the conduction times between the two pathways..

The baseline electrocardiogram (ECG) findings (Figure 1) were interpreted as supraventricular bigeminism. However, the electrophysiologic study showed that it was actually a spontaneous repetitive double nodal response that triggered runs of tachycardia (Figure 2A) and atrial fibrillation. The atrial activation occurred through both nodal pathways simultaneously, but at differing conduction velocities (Figure 2B), sometimes with posterior retrograde conduction by the fast pathway, which perpetuated it (Figure 2, Figure 3). Following ablation of the slow nodal pathway, the double response and runs of tachycardia disappeared (Figure 2D) and a continuous, decreasing AV and VA conduction pattern was seen..

Figure 1.

Figure 2.

Figure 3.

During follow-up, the patient remained asymptomatic, with stable sinus rhythm and no antiarrhythmic treatment. No recurrence was documented on Holter ECG at 3, 6, or 12 months..

Corresponding author: mrodrig3@hotmail.com

Idiomas
Revista Española de Cardiología (English Edition)

Subscribe to our newsletter

Article options
Tools
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

es en
Política de cookies Cookies policy
Utilizamos cookies propias y de terceros para mejorar nuestros servicios y mostrarle publicidad relacionada con sus preferencias mediante el análisis de sus hábitos de navegación. Si continua navegando, consideramos que acepta su uso. Puede cambiar la configuración u obtener más información aquí. To improve our services and products, we use "cookies" (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here.