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AVNRT — EECC MCQ

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ModerateArrhythmia & ElectrophysiologyAVNRTEECC

A 50-year-old man presents with recurrent episodes of rapid regular palpitations lasting 30-60 minutes, associated with polyuria after termination. The episodes start and stop abruptly. His ECG during an episode shows a narrow-complex tachycardia at 180 bpm with pseudo r-prime in V1 and pseudo S-waves in the inferior leads. What is the most likely diagnosis?

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Correct answer: A — Atrioventricular nodal re-entrant tachycardia (AVNRT)

Explanation lettering: D = shown as A · E = shown as C · A = shown as D · C = shown as E

Classic features of AVNRT include sudden onset/offset, regular narrow-complex tachycardia, post-tachycardia polyuria (due to ANP release), and the ECG hallmark of pseudo r-prime in V1 and pseudo S-waves in inferior leads (retrograde P-waves buried in QRS). AF (A) would be irregularly irregular. Flutter (B) shows sawtooth waves. AVRT (D) may look similar but the pseudo r-prime/pseudo S pattern is more characteristic of typical AVNRT. Atrial tachycardia (E) has visible P-waves with warm-up/cool-down.

Reference: ESC (2019): Guidelines for the Management of Patients with Supraventricular Tachycardia