Supraventricular tachyarrhythmias may be caused by macroreentry circuits involving the AV node and accessory pathways. This paper reports a case of suspected orthodromic atrioventricular reciprocating tachycardia in an 18-month-old Dalmatian admitted with dyspnea and a lifelong history of fatigue. Cardiac auscultation documented a regular fast pace with no heart murmurs. The electrocardiogram characteristics were consistent with supraventricular tachycardia, with very regular RR interval and narrow QRS complexes. At lead II, we identified negative P waves buried within the ST segment, which resulted in a RP-to-PR ratio of 0.60, but in aVR these P waves were positive, suggesting a retrograde conduction of electrical impulses throughout the atrial myocardium. The echocardiographic study showed volume overload, and a decreased fractional shortening was calculated when SVT was sustained, highlighting its impact on systolic function. This is likely the first description of an orthodromic atrioventricular reciprocating tachycardia in a Dalmatian, and although cardiac mapping was not available to confirm this suspicion, all electrocardiograpic features were supportive of such arrhythmia.
References
[1]
Fox, D.J., Tischenko, A., Krahn, A.D., Skanes, A.C., Gula, L.J., Yee, R.K. and Klein, G.J. (2008) Supraventricular Tachycardia: Diagnosis and Management. Mayo Clinic Proceedings, 83, 1400-1411. https://doi.org/10.4065/83.12.1400
[2]
Chetaille, P.C., Walsh, E.P. and Triedman, J.K. (2004) Outcomes of Radiofrequency Catheter Ablation of Atrioventricular Reciprocating Tachycardia in Patients with Congenital Heart Disease. Heart Rhythm, 1, 168-173.
https://doi.org/10.1016/j.hrthm.2004.03.064
[3]
Santilli, R.A. and Bussadori, C. (2000) Orthodromic Incessant Atrioventricular Reciprocating Tachycardia in a Dog. Journal of Veterinary Cardiology, 2, 25-29.
https://doi.org/10.1016/S1760-2734(06)70004-2
[4]
Santilli, R.A., Spadacini, G., Moretti, P., Perego, M., Perini, A., Tarducci, A., Crosara, S. and Salerno-Uriarte, J.A. (2006) Radiofrequency Catheter Ablation of Concealed Accessory Pathways in Two Dogs with Symptomatic Atrioventricular Reciprocating Tachycardia. Journal of Veterinary Cardiology, 8, 157-165.
https://doi.org/10.1016/j.jvc.2006.06.001
[5]
Coumel, P., Cabrol, C., Fabiato, A., Gourgon, R. and Slama, R. (1967) Permanent Tachycardia by Reciprocal Rhythm. Evidence of Atrial and Ventricular Pacing Diagnosis. Archives of Heart and Vessels Disease, 60, 1830-1864.
[6]
Amara, W. and Monsel, F. (2013) Incessant Tachycardia Revealing a Coumel Type Reentrant tachycardia. Annals of Cardiology and Angiology, 62, 361-363.
https://doi.org/10.1016/j.ancard.2013.08.015
[7]
Badhwar, N. (2010) Introduction to Supraventricular Tachycardia. Cardiac Electrophysiology Clinics, 2, 179-181. https://doi.org/10.1016/j.ccep.2010.01.001
[8]
Buttà, C., Tuttolomondo, A., Di Raimondo, D., Milio, G., Miceli, S., Attanzio, M.T., Giarrusso, L., Licata, G. and Pinto, A. (2013) The Supraventricular Tachycardias: Proposal of a Diagnostic Algorithm for the Narrow Complex Tachycardias. Journal of Cardiology, 61, 247-255. https://doi.org/10.1016/j.jjcc.2012.11.008
[9]
Bonney, W.J. and Shah, M.J. (2013) Incessant SVT in Children: Ectopic Atrial Tachycardia and Permanent Junctional Reciprocating Tachycardia. Progress in Pediatric Cardiology, 35, 33-40. https://doi.org/10.1016/j.ppedcard.2012.11.005
Gompf, R.E. (2016) History and Physical Examination. In: Smith Jr., F.W.K., Tilley, L.P., Oyama, M.A., Sleeper, M.M., Eds., Manual of Canine and Feline Cardiology, 5th Edition, Elsevier, St. Louis Missouri, 3-24.
[12]
Atkins, C.E., Kanter, R., Wright, K., Saba, Z., Baty, C., Swanson, C., Bai, S. and Keene, B.W. (1995) Orthodromic Reciprocating Tachycardia and Heart Failure in a Dog with a Concealed Posteroseptal Accessory Pathway. Journal of Veterinary Internal Medicine, 9, 43-49. https://doi.org/10.1111/j.1939-1676.1995.tb03271.x
[13]
Wright, K.N., Atkins, C.E. and Kanter, R. (1996) Supraventricular Tachycardia in Four Young Dogs. Journal of the American Veterinary Medical Association, 208, 75-80.
[14]
Santilli, R.A., Diana, A. and Toaldo, M.B. (2012) Orthodromic Atrioventricular Reciprocating Tachycardia Conducted with Intraventricular Conduction Disturbance Mimicking Ventricular Tachycardia in an English Bulldog. Journal of Veterinary Cardiology, 14, 363-370. https://doi.org/10.1016/j.jvc.2012.04.001
[15]
Santilli, R.A., Perego, M. and Crosara, S. (2008) Utility of 12-Lead Electrocardiogram for Differentiating Paroxysmal Supraventricular Tachycardias in Dogs. Journal of Veterinary Internal Medicine, 22, 915-923.
https://doi.org/10.1111/j.1939-1676.2008.0127.x
[16]
Jaeggi, E.T., Gilljam, T., Bauersfeld, U., Chiu, C. and Gow, R. (2003) Electrocardiographic Differentiation of Typical Atrioventricular Node Reentrant Tachycardia from Atrioventricular Reciprocating Tachycardia Mediated by Concealed Accessory Pathway in Children. The American Journal of Cardiology, 9, 1084-1089.
https://doi.org/10.1016/S0002-9149(03)00153-X
[17]
Meiltz, A., Weber, R., Halimi, F., Defaye, P., Boveda, S. and Zimmermann, M. (2006) Permanent Form of Junctional Reciprocating Tachycardia in Adults: Peculiar Features and Results of Radiofrequency Catheter Ablation. Europace, 8, 8-21.
https://doi.org/10.1093/europace/euj007
