Response to spontaneous and induced His refractory ventricular premature
beats during long RP tachycardia. What is the mechanism?
Abstract
CLINICAL PROBLEM: A 43-year-old lady with no evidence of
structural heart disease underwent an electrophysiological study for the
evaluation of recurrent episodes of palpitations. A narrow complex
regular tachycardia was documented, which was not reverted with
intravenous adenosine administration. There was no basal pre-excitation.
The AH and HV intervals during sinus rhythm were 70ms and 48ms
respectively. A regular narrow complex long RP tachycardia with
concentric atrial activation was induced which was incessant in nature.
Ventricular overdrive pacing from RV septum during tachycardia at 20 ms
earlier than tachycardia cycle length showed pseudo-V-A-A-V response
with VA linking on cessation of pacing. A His refractory ventricular
premature beat (VPB) was delivered during the tachycardia (Figure 1). A
spontaneous catheter induced VPB was noted after 2 beats. What are the
observations and mechanisms?