We describe a case of an otherwise healthy 50-year-old man with frequent attacks of heart palpitations. During electrophysiological study two episodes of atrial fibrillation (AF) were induced. In both cases AF was preceded by a few seconds of atrioventricular nodal reentrant tachycardia (AVNRT). Ablation of atrioventricular node slow pathway successfully eliminated both tachyarrhythmias during 6 months follow-up. Since during AVNRT a few short coupled atrial ectopic beats appeared, we hypothesized that AVNRT did not trigger AF directly but by inducing ectopic beats form a pulmonary vein or an atrial focus that became a direct trigger of AF.
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