Spontaneous manifestation of dual AV nodal pathways resulting in complex patterns of AV conduction

Dual intranodal pathways are not uncommonly demonstrated at electophysiological study especially in patients with intranodal re-entrant tachycardias. This type of tachycardia is the most common spontaneous manifestation (albeit indirect) of dual AV nodal pathways. Other forms of spontaneous expression of dual atrio-His conduction are rare. In this report we describe a patient who exhibited complex atrioventricular conduction patterns over two intranodal pathways.