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Narrow complex tachycardia with alternating atrial activation: What is the Mechanism?
  • Ahmed T. Mokhtar,
  • George Klein,
  • Allan Skanes
Ahmed T. Mokhtar
King Abdulaziz University Faculty of Medicine

Corresponding Author:atmokhtar@kau.edu.sa

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George Klein
London Health Sciences Centre University Hospital
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Allan Skanes
London Health Sciences Centre University Hospital
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Abstract

Case Presentation: A 50-year male was referred for consideration of a redo ablation procedure. 2 years before this referral, he was diagnosed with an episode of pre-excited atrial fibrillation, and underwent an attempt at a left lateral pathway ablation. The index attempt with radiofrequency ablation did not eliminate the pathway and he was discharged on oral flecainide. The procedure was also complicated by a right-sided deep vein thrombosis and further attempts at a redo procedure were delayed. However, he developed recurrent episodes of palpitations 2 years after his index procedure. Hence, he was referred for a second attempt at ablation. His baseline 12-lead ECG did not show any evidence of manifest pre-excitation. During his EP study, pre-excitation was seen with atrial extrastimuli and with shorter intervals, a narrow complex tachycardia was induced (Figure [1](#fig-cap-0001)). However, the atrial activation appeared to alternate at times, despite the tachycardia being sustained. What is the mechanism of the alternating atrial activation?
08 Jun 2024Submitted to Journal of Cardiovascular Electrophysiology
11 Jun 2024Submission Checks Completed
11 Jun 2024Assigned to Editor
11 Jun 2024Review(s) Completed, Editorial Evaluation Pending
17 Jun 2024Editorial Decision: Revise Minor
22 Jun 20241st Revision Received
24 Jun 2024Submission Checks Completed
24 Jun 2024Assigned to Editor
24 Jun 2024Review(s) Completed, Editorial Evaluation Pending
24 Jun 2024Reviewer(s) Assigned
28 Jun 2024Editorial Decision: Accept