CASE REPORT article
Front. Cardiovasc. Med.
Sec. Cardiac Rhythmology
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1612805
This article is part of the Research TopicCardioimmunology and Arrhythmias: Mechanism, Diagnosis and Novel TherapyView all 3 articles
AVNRT Complicated by Valsalva-Exacerbated Radial Pulsation Artifacts Mimicking Acute Ischemia: A Case Report
Provisionally accepted
- 1Meishan City People's Hospital, Meishan, China
- 2Pengshan District Traditional Chinese Medicine Hospital, Meishan, China
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Atrioventricular nodal reentrant tachycardia (AVNRT), the most common supraventricular tachycardia, occasionally present with transient ST-T changes mimicking ischemia, posing diagnostic challenges for patients. We report an 82-year-old woman with paroxysmal palpitations whose initial ECG demonstrated supraventricular tachycardia (154 bpm) accompanied by dynamic ST-segment elevation and T-wave inversion in leads I, II, aVL, and aVF, while lead III remained unaffected. Repositioning electrodes away from the right radial artery pulsation resolved these deviations, confirming their artifactual origin. The electrophysiological study confirmed the diagnosis of atrioventricular nodal reentrant tachycardia (AVNRT), and successful radiofrequency catheter ablation was performed with no recurrence during 6-month follow-up. Notably, breath-holding during tachycardia exacerbated pulsation artifacts by altering hemodynamic forces, a phenomenon further validated through provocative Valsalva maneuvers. This case highlights that limb pulsation artifacts-localized via Einthoven's triangle principles (sparing lead III)-can mimic ischemic patterns, particularly under tachycardia and breath-holding. Clinicians should prioritize ECG artifact exclusion through lead adjustment and dynamic testing to avoid unnecessary invasive interventions.
Keywords: case report, AVNRT, ECG artifact, ST-T changes, Valsalva Maneuver
Received: 16 Apr 2025; Accepted: 09 Jun 2025.
Copyright: © 2025 Li, Can, Ding, Liu and Ding. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Huaisheng Ding, Meishan City People's Hospital, Meishan, China
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