A case of a 30-year-old male with paroxysmal long RP tachycardia is presented. During electrophysiological study the clinical
arrhythmia (atypical atrioventricular nodal reentrant tachycardia – AVNRT) was misdiagnosed as ectopic left atrial tachycardia due
to ventricle-atrium-atrium-ventricle (VAAV) response after entrainment, eccentric atrial activation sequence and easiness in achieving
atrio-ventricular dissociation with ventricular pacing during the tachycardia. Reassessment of the VAAV response lead to recognition
of pseudo-VAAV response often seen in atypical, fast-slow AVNRT. Subsequent ablation of the slow pathway at standard site in the
triangle of Koch was successful in eliminating the tachycardia.
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