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Europace. 2010 January; 12(1): 36.
Published online 2009 October 28. doi:  10.1093/europace/eup316
PMCID: PMC2860713

Pseudo-atrial fibrillation due to non-reentrant AV nodal tachycardia

A 40-year-old man was referred for an atrial fibrillation (AF) ablation. Close examination of his Holter recording was suggestive of intermittent atrial activity (Panel A). The patient underwent a comprehensive electrophysiology study which demonstrated simultaneous fast and slow pathway activation, or ‘one for two’, due to dual AV nodal physiology (Panel B). Slow pathway modification eliminated the tachycardia.

Non-reentrant AV nodal tachycardia is rare, and can be mistaken for AF due to its irregular rhythm with difficult to visualize P-waves. Careful examination of the surface ECG can avoid an erroneous diagnosis of AF and institution of unnecessary therapy.

Conflict of interest: none declared.

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