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Narrow QRS Tachycardia with Transition: What Is the Mechanism?

Krishna Kumar Mohanan Nair, Narayanan Namboodiri, Bharatraj Banavalikar, Sonali Inamdar, Ajitkumar Valaparambil, Anees Thajudeen, Jaganmohan Tharakan
Pacing and Clinical Electrophysiology : PACE 2016 September
A 50-year-old woman underwent radiofrequency catheter ablation of narrow QRS tachycardia that was terminated with intravenous adenosine. Twelve-lead electrocardiogram was normal during sinus rhythm. The electrophysiological study showed normal atriohisian and hisioventricular intervals during sinus rhythm. Atrial burst pacing reproducibly induced two narrow QRS tachycardias. Figure 1 shows spontaneous switch of tachycardia 1 to tachycardia 2. What are the likely mechanisms of the tachycardia and the transition?

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