We present a case of antidromic AVRT involving an atriofascicular pathway in a patient with an atretic coronary sinus os. This patient had left ventricular dysfunction with rate-related left bundle branch block aberrancy in sinus rhythm. In the electrophysiology lab, there was VA dissociation for a few beats during antidromic tachycardia. The possible mechanisms that could explain this intracardiac finding are discussed.
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Multiple accessory pathways (APs) can develop in patients with Ebstein anomaly. Rarely, these APs can participate in antidromic atrioventricular reentrant tachycardia (AVRT) which can be life-threatening and requires unique considerations for acute management and ultimate ablation. These considerations are discussed herein.
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