Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2024 Feb 22;10(5):321-325.
doi: 10.1016/j.hrcr.2024.02.008. eCollection 2024 May.

Duodromic tachycardia: A case report of a rare presentation of wide complex supraventricular tachycardia

Andrew Headrick  1 , Claire Newlon  2 , Susan P Etheridge  1 , S Yukiko Asaki  1 , Thomas Pilcher  1 , Mary Niu  1
Affiliations
Case Reports

Duodromic tachycardia: A case report of a rare presentation of wide complex supraventricular tachycardia

Andrew Headrick et al. HeartRhythm Case Rep. .
No abstract available

Keywords: Accessory pathway; Atrioventricular reentrant tachycardia; Duodromic tachycardia; Electrophysiology study; Supraventricular tachycardia; Wide complex tachycardia.

PubMed Disclaimer

Conflict of interest statement

Dr Thomas Pilcher receives compensation for speaking and teaching from Abbott Medical. The remaining authors have no other conflicts of interest to disclose.

Figures

Figure 1
Figure 1
A: Presenting electrocardiogram (ECG) with a wide complex tachycardia with a right bundle branch block pattern and superior axis. B: Twelve-lead rhythm strip with subtle variation in the QRS duration and morphology in the precordial leads. C: Ventricular pre-excitation in sinus rhythm following cardioversion has a left bundle branch block morphology, distinctly different from panel A. D: Postablation ECG in sinus rhythm with no pre-excitation.
Figure 2
Figure 2
Differences in conduction unmasked with atrial and ventricular pacing maneuvers. A: During decremental atrial pacing from the high right atrium (HRA), at 290 ms pre-excitation changes from left bundle branch block (LBBB) to right bundle branch block (RBBB) morphology on the surface leads. B: The right accessory pathway (AP) effective refractory period occurred at 600/340 ms and corresponds to a change in pre-excitation from LBBB to RBBB. C: During para-Hisian ventricular decremental pacing, the local ventriculoatrial (VA) conduction on the HRA channel lengthens at 290 ms while the VA conduction on the coronary sinus (CS) channels remain unchanged. D: Para-Hisian ventricular extrastimulus pacing at 400/270 results in retrograde block over the right AP and exclusive retrograde conduction over the left AP; this is followed by antegrade conduction through the atrioventricular node.
Figure 3
Figure 3
A: Mapping and ablation of the left accessory pathway (AP) with differential left ventricular (LV) pacing localizes the earliest retrograde activation to 3 o’clock on the lateral mitral valve annulus (D). Radiofrequency (RF) application results in retrograde block through the left AP and local ventriculoatrial separation on the ablation channels (A). Note that even at longer cycle lengths (500 ms in panel A), LV pacing promotes conduction over the left AP and the earliest atrial signals are localized to the distal coronary sinus (CS). B: Mapping and ablation of the right AP in pre-excited sinus rhythm localizes the earliest retrograde activation to 12 o’clock on the tricuspid valve annulus (E). C: Para-Hisian right ventricle mapping and ablation of the right AP. Following RF application, the VA conduction changes on the distal ablation channel (C, blue box). Red spheres indicate RF lesions, while yellow sphere localizes His.
See this image and copyright information in PMC

References

    1. Wellens H.J. Electrophysiology: ventricular tachycardia: diagnosis of broad QRS complex tachycardia. Heart. 2001;86:579–585. - PMC - PubMed
    1. Pambrun T., El Bouazzaoui R., Combes N., et al. Maximal pre-excitation based algorithm for localization of manifest accessory pathways in adults. JACC Clin Electrophysiol. 2018;4:1052–1061. - PubMed
    1. Ban J.-E., Chen Y.-L., Park H.-C., et al. Idiopathic ventricular arrhythmia originating from the para-Hisian area: prevalence, electrocardiographic and electrophysiological characteristics. J Arrhythm. 2014;30:48–54.
    1. Zachariah J.P., Walsh E.P., Triedman J.K., et al. Multiple accessory pathways in the young: the impact of structural heart disease. Am Heart J. 2013;165:87–92. - PMC - PubMed
    1. Nakamura T., Kanda G., Sasaki Y., et al. Wide QRS tachycardia associated with multiple accessory pathways in a patient with Wolff-Parkinson-White syndrome. J Cardiol Cases. 2019;20:191–196. - PMC - PubMed

Publication types

LinkOut - more resources