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What is the diagnosis of palpitations? A case report of rate-dependent retrograde conduction over an accessory pathway
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  • Xueyan Ding,
  • chengyong shi,
  • Song-qun Huang,
  • Lihong Wang,
  • xinmiao huang
Xueyan Ding
Zhejiang Provincial People's Hospital
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chengyong shi
903rd Hospital of the Chinese People’s Liberation Army
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Song-qun Huang
The Second Military Medical University
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Lihong Wang
Zhejiang Provincial People's Hospital
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xinmiao huang
Changhai Hospital

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Introduction: The phenomenon of intermittent retrograde conduction over an accessory pathway (AP) is very rare. Methods: We report a case of AVRT without ventricular pre-excitation and arrhythmia recorded. Stepwise decremental pacing was delivered from RV apex. When the pacing CL was shortened to 400 ms, Retrograde ventriculoatrial (V-A) Wenckebach-type block appeard with the earliest atrial activation at the ostium of CS. The S1S2 interval was first set to 450ms and then reduced by 10ms and atrial-ventricular node ERP (AVNERP) occurred at 500ms/410ms. Results: Retrograde conduction over an AP was present only during ventricular pacing with a fast pacing rate (S1S1 300ms, S1S2 500ms/290ms) and narrow QRS tachycardia was induced by atrial programmed stimulation. The AP was ablated successfully in the end. Conclusion: It is suggested that careful evaluation by EPS should be applied during baseline study, especially in the case without arrhythmia recorded.