Six mechanisms of supraventricular tachycardia in the same patient: Report of a case

An 18-year-old girl had been suffering from palpitations for 3 years. After a normal and asymptomatic pregnancy, she became highly symptomatic with more than 6 tachycardia paroxysms a week, many of them requiring emergency hospitalizations because of hemodynamic collapse. The electrophysiological evaluation revealed dual A-V nodal pathways and the presence of 4 accessory pathways (3 in the left A-V ring: lateral, posterior, and posteroseptal, 1 right posteroseptal) with 5 types of atrioventricular tachycardia and atrial flutter. The 4 accessory pathways and the slow A-V nodal pathway were successfully ablated, and the patient has been asymptomatic for 12 months without taking antiarrhythmic drugs.