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Short RP tachycardia with Concentric atrial activation: What is the mechanism?
  • Anindya Ghosh,
  • Chenni S. Sriram,
  • Ulhas M. Pandurangi
Anindya Ghosh
Madras Medical Mission Institute of Cardio Vascular Diseases
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Chenni S. Sriram
Children's Hospital of Michigan
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Ulhas M. Pandurangi
Madras Medical Mission Institute of Cardio Vascular Diseases

Corresponding Author:[email protected]

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A 65 year-old with history of prior ablations for regular narrow QRS short- RP tachycardia presented with recurrence of palpitations. An electrophysiological study showed long VA tachycardia with concentric atrial activation with a left ventricular origin extrastimulus delivered during His refractoriness, advancing the next ‘A’. A HRVPB can only reset an ORT if it ‘pulls in’ the local V at the ventricular insertion of an accessory pathway. As showcased in this case, erudite analysis of the pattern of perturbation of local ventricular electrograms is of paramount significance when interpreting responses to this maneuver. This concept when fortified with a heightened index of clinical suspicion for mitral annular block, anatomical knowledge of the pattern of LA-CS muscular connections, and pathway orientation, led to accurate electrophysiological diagnosis and management.
22 Feb 2023Submitted to Journal of Cardiovascular Electrophysiology
22 Feb 2023Review(s) Completed, Editorial Evaluation Pending
22 Feb 2023Submission Checks Completed
22 Feb 2023Assigned to Editor
24 Feb 2023Editorial Decision: Revise Minor
07 Mar 20231st Revision Received
07 Mar 2023Submission Checks Completed
07 Mar 2023Assigned to Editor
07 Mar 2023Review(s) Completed, Editorial Evaluation Pending
11 Mar 2023Editorial Decision: Accept