Atrioventricular Node Reentry Supraventricular Tachycardia Differential Diagnoses

Updated: Jan 25, 2022
  • Author: Glenn T Wetzel, MD, PhD; Chief Editor: Stuart Berger, MD  more...
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DDx

Diagnostic Considerations

The permanent form of junctional reciprocating tachycardia (PJRT) can be difficult to distinguish from atypical (fast-slow) atrioventricular node reentrant tachycardia (AVNRT). [13, 14, 15] However, the response to premature atrial complexes (PACs) allows for differentiation between these two arrhythmias: His refractory PACs (HrPACs) perturbing the next His (resetting with fusion) is diagnostic of AVRNT, as late PACs that fuse with the native beats are not able to reset the focal source of junctional tachycardia. [15] However, simultaneous conduction through the AV nodal fast and slow pathways (ie, two-for-one response [TFOR]) can occur in both AVNRT and junctional tachycardia and, therefore, early PAC advancing the immediate His with continuation of tachycardia is not diagnostic of junctional tachycardia. [15]

Another rare mechanism is verapamil-sensitive atrial tachycardia originating from near the atrioventricular node. [16]

Differential Diagnoses