Electrocardiographical case. Narrow complex tachycardia provoked by the Valsalva manoeuvre

Koh CH, Foo D, Ng KS, Chong CH
Correspondence: Dr Koh Choong Hou, xjunhao@gmail.com

ABSTRACT
A 19-year-old Chinese man presented with tachyarrhythmia during a human centrifuge session while performing a Valsalva manoeuvre at near normal (+1.4 Gz) centripetal forces. It was likely that the hydrostatic effects of sustained centrifugal forces, the distortion of the heart’s shape, as well as swings in the autonomic dominance pre- and post-Valsalva manoeuvre, contributed to the tachyarrhythmia. The 12-lead ECG showed a narrow complex tachycardia with visible P-waves after the QRS complexes consistent with a long R-P’ tachycardia. The intracardiac electrogram demonstrated a concentric retrograde atrial activation during narrow complex tachycardia. The V-A interval was 150 ms which was much longer than in typical atrioventricular nodal reentry tachycardia, which is usually less than 70 ms. The A-H interval was short and the H-A interval was long, indicating that antegrade activation was over the fast pathway and retrograde activation was over the slow pathway. The diagnosis was atypical atrioventricular nodal reentry tachycardia, and radiofrequency ablation was successfully applied to the slow AV nodal pathway.

Keywords: atrioventricular nodal reentry tachycardia, centrifugal forces, narrow complex tachycardia, tachyarrythymia, Valsalva manoeuvre
Singapore Med J 2009; 50(4): 438-441