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      Case report: Dual atrioventricular nodal non-reentrant tachycardia with six types of ECG patterns leading to tachycardia-induced cardiomyopathy in a 51-year-old man


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          More than three types of ECG manifestations in one patient with dual atrioventricular nodal non-reentrant tachycardia (DAVNNT) are rare. We report a 51-year-old male patient with DAVNNT consisting of six types of ECG patterns leading to tachycardia-induced cardiomyopathy. After radiofrequency ablation of the slow pathway, DAVNNT was eliminated and cardiac function was restored.

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          Dual atrioventricular nodal non-re-entrant tachycardia.

          Dual atrioventricular nodal non-re-entrant tachycardia (DAVNNT), also known as 'double fire', has recently received more attention since it was demonstrated to mimic more common arrhythmias such as atrial premature beats, atrial fibrillation, and ventricular tachycardia. This is important, since mistaken differential diagnoses and the resulting therapeutic decisions have severe consequences for affected patients. DAVNNT is characterized by conduction characteristics of the atrioventricular (AV) node that leads to a double antegrade conduction of one sinoatrial nodal activity via the slow and fast AV nodal pathways. As a result, the most significant hint from an electrocardiogram (ECG) is a P wave followed by two narrow QRS complexes. Although DAVNNT is rather a rare arrhythmia, it now appears to be more common than previously thought. To date, 68 cases including 3 small single-centre observational studies accumulated over the last 5 years have demonstrated the feasibility and safety of radiofrequency catheter ablation for DAVNNT. Catheter ablation treats this arrhythmia effectively by modifying or eliminating slow pathway function. Here, we review the current state of DAVNNT knowledge systematically and address current challenges presented by this 'ECG chameleon from the AV node'.
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            New manifestations of dual A-V nodal pathways.

            Electrophysiological studies with extrastimulus technique demonstrated evidence of dual A-V pathways in two patients with paroxysmal supraventricular tachycardia (PSVT). In case one, the second P of paced Wenckebach sequences was followed by two conducted QRS complexes without an intervening P wave. The A-H of the first and second QRS were consistent with the fast and slow pathway conduction times. The second QRS was followed by an atrial echo and PSVT, suggesting that the first pathway was available for retrograde propagation following the second QRS. In case two, PSVT was induced with atrial extrastimulus, followed by development of A-V dissociation. The two cases suggest the following conclusions: (1) dual A-V nodal pathways may allow the occurrence of double antegrade conduction of one P; (2) the atria are not necessary for A-V nodal circus movements in "dual pathway" A-V nodal reentrant PSVT.
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              Dual atrioventricular nodal nonreentrant tachycardia: a systematic review.

              T. Wang (2011)
              Dual atrioventricular nodal nonreentrant tachycardia (DAVNNT) is a relatively uncommon supraventricular tachycardia. The clinical characteristics and optimal management strategies are not well described. A systematic review of all reported cases of DAVNNT was performed. Articles were included if they described spontaneous tachycardias resulting from 1:2 atrioventricular (AV) conduction as a result of two AV nodal pathways. Data sources included PubMed from 1950 to January 2011, article bibliographies, and the Google internet search engine. Ultimately, 44 citations that reported 49 cases met inclusion criteria. DAVNNT is being reported with increasing frequency. Clinical characteristics were assessed using the 44 cases reported in the English language. Palpitations were the most common presenting symptom (89%). The majority of patients had a significant delay until the correct diagnosis was made (77%). The most common specific mistaken diagnosis was atrial fibrillation (32%) and five patients were diagnosed after referral for pulmonary vein isolation. Nine reports described association with a tachycardia-mediated cardiomyopathy. Catheter ablation has successfully treated all reported cases since 1994. DAVNNT is an uncommon arrhythmia being reported with increasing frequency. It is commonly mistaken for atrial fibrillation and is associated with a reversible tachycardia-mediated cardiomyopathy. Catheter ablation of the slow AV nodal pathway is curative and appears to be the therapy of choice, although more systematic study is required. ©2011, The Author. Journal compilation ©2011 Wiley Periodicals, Inc.

                Author and article information

                Front Cardiovasc Med
                Front Cardiovasc Med
                Front. Cardiovasc. Med.
                Frontiers in Cardiovascular Medicine
                Frontiers Media S.A.
                12 October 2022
                : 9
                : 998453
                [1] 1Shandong Medicine and Health Key Laboratory of Cardiac Electrophysiology and Arrhythmia, Department of Cardiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital , Jinan, China
                [2] 2Department of Cardiology, Beijing Anzhen Hospital, National Clinical Research Centre for Cardiovascular Diseases, Capital Medical University , Beijing, China
                [3] 3Division of Electrophysiology, Department of Cardiovascular Diseases, Mayo Clinic , Rochester, MN, United States
                Author notes

                Edited by: Matteo Anselmino, University of Turin, Italy

                Reviewed by: Pedro Brugada, UZ Brussel - VUB, Belgium; Hussam Ali, Center for Clinical Arrhythmology and Electrophysiology, MultiMedica Holding SpA (IRCCS), Italy

                *Correspondence: Ying-Long Hou, houyinglong@ 123456sina.com

                This article was submitted to Cardiac Rhythmology, a section of the journal Frontiers in Cardiovascular Medicine

                Copyright © 2022 Ren, Zhang, Zhang, Gao, Sang, Cha and Hou.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                : 20 July 2022
                : 26 September 2022
                Page count
                Figures: 4, Tables: 0, Equations: 0, References: 13, Pages: 7, Words: 2961
                Cardiovascular Medicine
                Case Report

                dual atrioventricular nodal non-reentrant tachycardia,electrocardiogram,cardiomyopathy,slow pathway,catheter ablation


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