Double Ventricular Response with Aberrant Conduction Leading to Ventricular Dysfunction

Paul W Warren; Adam W Powell; Timothy Knilans; Chad Connor; Shankar Baskar

doi:10.1007/s00246-024-03506-9

Double Ventricular Response with Aberrant Conduction Leading to Ventricular Dysfunction

Pediatr Cardiol. 2024 May 6. doi: 10.1007/s00246-024-03506-9. Online ahead of print.

Authors

Paul W Warren¹, Adam W Powell^{1

2}, Timothy Knilans^{1

2}, Chad Connor^{1

2}, Shankar Baskar^{3

4}

Affiliations

¹ The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnett Ave., MLC 2003, Cincinnati, OH, 45229-3026, USA.
² Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
³ The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnett Ave., MLC 2003, Cincinnati, OH, 45229-3026, USA. Shankar.Baskar@CCHMC.org.
⁴ Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA. Shankar.Baskar@CCHMC.org.

PMID: 38709261
DOI: 10.1007/s00246-024-03506-9

Abstract

Double ventricular response (DVR), where a single P wave results in two QRS complexes, is a rare presentation of dual AV node physiology. It has been associated with ventricular dysfunction in the setting of incessant tachycardia. We present the case of an otherwise healthy adolescent who had frequent DVR without tachycardia leading to left ventricular dysfunction. Slow pathway modification led to a significant reduction in ectopy and normalization of ventricular function. This highlights that DVR without tachycardia might lead to ventricular dysfunction in pediatric patients. Slow pathway modification with reduction of ectopy may be sufficient to restore ventricular function.

Keywords: Atrioventricular nodal reentry tachycardia; Double ventricular response; Dual AV nodal physiology; Dual atrioventricular nodal non-re-entrant tachycardia; Dual atrioventricular nodal physiology; Left ventricular dysfunction.