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Orthodromic AVRT With 2 Different Wide QRS Complexes Caused by Bilateral Bystander Nodoventricular Pathways.

Mihoko Kawabata, Shingo Maeda, Tatsuaki Kamata, Tomoyuki Kawashima, Ryo Yonai, Kaoru Okishige, Hirotsugu Atarashi, Kenzo Hirao
JACC. Case reports. 2023 December 21
We present a case of orthodromic atrioventricular re-entrant tachycardia exhibiting both right and left bundle branch block pattern wide QRS morphologies caused by bilateral bystander nodoventricular (NV) accessory pathways. These wide QRS morphologies came from pre-excitation accompanied by delta waves. In the context of NV accessory pathways, left-sided manifest NV accessory pathways are rare.

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