ArticleJACC. Case reports2026
Seamless Transition Between Narrow- and Wide-QRS Tachycardia Revealing Double Tachycardia.
Article in JACC. Case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundTransitions between narrow- and wide-QRS tachycardia are often attributed to supraventricular tachycardia with aberrant conduction; however, alternative mechanisms should be considered. CASE SUMMARY: A 59-year-old man presented with tachycardia that alternated between narrow- and wide-QRS morphologies with progressive fusion. Electrophysiologic study demonstrated coexistence of orthodromic atrioventricular reentrant tachycardia (AVRT) using a left lateral accessory pathway and ventricular tachycardia (VT) originating from the right ventricular outflow tract. During AVRT, spontaneous VT occurred and entrained the AVRT, accelerating the tachycardia cycle length. Spontaneous termination or slowing of VT resulted in immediate continuation of AVRT via retrograde conduction over the accessory pathway. Catheter ablation of the accessory pathway followed by VT focus ablation eliminated both tachycardias. DISCUSSION: This case illustrates double tachycardia consisting of orthodromic AVRT and VT originating from the right ventricular outflow tract, treated with radiofrequency catheter ablation. TAKE-HOME MESSAGE: Transitions between narrow- and wide-QRS tachycardia with fusion beats suggest double tachycardia.
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