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Intermittent PR Prolongation During Narrow QRS Complex Tachycardia
Rongbing Peng1, Chao Liu2, Ming Ni2
1Department of Cardiovascular Medicine, Changhai Hospital, Naval Medical University, Shanghai, China; The Sanya Rehabilitation and Recuperation Center of the PLA Joint Logistics Support Force, Sanya, Hainan, China.
Background:
The coexistence of focal atrial tachycardia (AT) originating from the left atrial appendage (LAA) with dual atrioventricular nodal pathways (DAVNP) is uncommon and presents distinct ablation challenges.
Case Summary:
A 31-year-old female woman with intermittent palpitations for 1 year was referred to our medical center for catheter ablation after an abnormal electrocardiogram. There was no personal or family history of cardiovascular disease or congenital anomalies.
Discussion:
This case highlights the diagnostic complexity of a rare apical LAA-origin AT with DAVNP that required comprehensive electrophysiological study for confirmation. Successful focal ablation was achieved, prioritizing this strategy over LAA isolation given patient-specific factors and anatomical challenges.
Take-Home Message:
The diagnosis of apical LAA AT with DAVNP is extremely challenging on electrocardiogram, requiring comprehensive mapping for diagnosis and for guiding a successful, individualized ablation strategy.
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