Dual AV nodal paths leading to AV nodal reentrant tachycardia

A 27-year-old white female with a history of paroxysmal supraventricular tachycardia presented to the emergency department complaining of intermittent palpitations. Although no tachydysrhythmia was present, she was noted to have two distinct PR intervals during normal sinus rhythm while in the emergency department. The patient was referred for electrophysiologic study. This study demonstrated dual AV nodal paths, and AV nodal reentrant tachycardia was induced and terminated. She was placed on flecainide for outpatient management of her dysrhythmia. Dual AV nodal pathways leading to AV nodal reentrant tachycardia is discussed.