While it’s established the relationship between atrial fibrillation and stroke, we know less about AV nodal reentrant tachycardia and cerebral embolism. Clinical case We studied a case of a 79 year old man, with diabetes and sistemic hypertension, without other comorbidities, who had been hospitalized after dysartria and sudden weakness of legs. Brain MRI showed multiple ischemic lesions, some of which were recent. This old man had suffered from palpitations since he was young, and used to stop these symtoms with vagal manoeuvres. An ECG showed normal sinus rhythm. No atrial fibrillationwas ever documented. Since we suspected a cardiogenic source of embolism, we performed an EP study and a pattern of AV nodal reentrant tachycardia was found. We induced an AVNRT at 170 bpm and a fast degeneration into the atrial fibrillation was observed in the EP lab. After spontaneous SR restoration (30 min after), slow pathway was successfully ablated. AF was not inducible with aggressive stimulation. Tha patient was discharged without antiplatelet therapy and he is still symptom-free (1 year after).
Conclusions:This case shows as AVNRT may sometimes be the cause of cardiac embolism, mainly in older patients with a long lasting hystory of palpitations. In our opinion EP study must be performed when the clear source of cardiac embolism can not be found and tehre’s a strong suspicion that atrial fibrillation is triggered by other easily curable arrhythmias.