Paroxysmal supraventricular tachycardia caused by 1: 2 atrioventricular conduction in the presence of dual atrioventricular nodal pathways

One-to-two atrioventricular conduction, ie, the double response to a single sinus or atrial impulse, resulting in two QRS complexes for one P wave, is a rare manifestation of dual atrioventricular (AV) nodal pathways. This report describes the case of a 61-year-old woman with continuous episodes of supraventricular tachycardia caused by independent conduction to the ventricles of sinus impulses over both the fast and the slow AV nodal pathway, giving rise to a ventricular rate that was twice the sinus rate. A wide spectrum of electrocardiographic manifestations of 1:2 AV conduction was observed on the surface electrocardiogram. The diagnosis was suggested by several elements including evidence of dual AV nodal pathways during sinus rhythm and cycle length alternans during tachycardia. The patient underwent successful slow pathway ablation with complete disappearance of symptoms and electrocardiographic manifestations of 1:2 AV conduction.