Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 6, 2020; 8(21): 5420-5425
Published online Nov 6, 2020. doi: 10.12998/wjcc.v8.i21.5420
Rare narrow QRS tachycardia with atrioventricular dissociation: A case report
Chao Zhu, Ming-Xing Chen, Gui-Jian Zhou
Chao Zhu, Ming-Xing Chen, Gui-Jian Zhou, Department of Cardiology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou 225009, Jiangsu Province, China
Author contributions: Zhu C and Chen MX were the patient’s oncologists, reviewed the literature, and contributed to manuscript drafting; Zhou GJ analyzed and interpreted the imaging findings; Zhou GJ reviewed and edited the manuscript; All authors read and approved the final manuscript.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Gui-Jian Zhou, PhD, Doctor, Department of Cardiology, The Affiliated Hospital of Yangzhou University, Yangzhou University, No. 88 University South Road, Yangzhou 225009, Jiangsu Province, China. zhoujian_1983007@163.com
Received: February 14, 2020
Peer-review started: February 14, 2020
First decision: August 21, 2020
Revised: September 5, 2020
Accepted: September 23, 2020
Article in press: September 23, 2020
Published online: November 6, 2020
Abstract
BACKGROUND

Most Mahaim fibers are right free-wall atriofascicular accessory pathways with only antegrade conduction. Concealed Mahaim fiber is not very rare; however, concealed nodoventricular fiber is a very rare kind of retrograde accessory pathway in supraventricular tachycardia with atrioventricular (AV) dissociation. Only a few cases about successful ablation of the nodoventricular accessory pathway have been reported. We describe the case of a 32-year-old woman who underwent an electrophysiology study and radiofrequency (RF) ablation of a rare narrow QRS tachycardia with AV dissociation.

CASE SUMMARY

A 32-year-old woman with a history of paroxysmal palpitation was admitted to our hospital for RF ablation. Electrocardiography revealed a narrow QRS complex tachycardia with the same morphology in sinus rhythm. Echocardiography showed no structural heart disease. A right-sided concealed AV accessory pathway and a right-sided concealed nodoventricular accessory pathway were involved in the orthodromic atrioventricular reciprocating tachycardia. His bundle-ventricular interval during tachycardia was the same as that in sinus rhythm. The tachycardia could be initiated and entrained by ventricular pacing. Premature right ventricular stimulus introduced during the His-bundle refractory period when tachycardia occurred was able to advance the next atrial potential. The earliest atrial activation was mapped near the proximal slow AV nodal pathway. RF ablation of both accessary pathways was successfully performed under the guidance of a three-dimensional mapping system by recording the earliest retrograde atrial potential, and tachycardia could no longer be induced.

CONCLUSION

Narrow QRS tachycardia with AV dissociation is inducible by concealed nodoventricular fiber and ablated by recording the earliest retrograde atrial potential.

Keywords: Atrioventricular dissociation, Nodoventricular pathways, Ablation, Narrow QRS wave tachycardia, Mahaim fiber, Case report

Core Tip: Nodoventricular fiber mediated tachycardia is a very rare clinical presentation. We present herein a rare case of narrow QRS tachycardia with atrioventricular dissociation mediated by nodoventricular fiber. After successful ablation of the slow pathway area, tachycardia is no longer induced. This case highlights the importance of careful electrophysiological examination with tachycardia induced with atrioventricular dissociation but not with ventricular tachycardia. The atrial inserted area of the odoventricular fiber was around the slow pathway position.