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Differentiation of a duplicated atrioventricular nodal pathway

A 21-year-old man underwent an electrophysiological study for a long RP tachycardia. The baseline, atrial-His (AH), andHis-ventricular intervals were normal, and programmed ventricular stimulation demonstrated a midline atrial activation with retrograde jump. Figures 1A and B show the responses to para-Hisian and right ventricular (RV) basal versus apical pacing, respectively. The clinical tachycardia was induced during programmed atrial stimulation with an identical atrial activation sequence as that during ventricular stimulation.