Differential diagnosis of long RP tachycardia with inverted P waves in the inferior leads


A 60 yo with h/o HTN c/o SOB. What is the rhythm?


Image 1

This is a regular narrow complex tachycardia (NCT) at  rate of about  167 bpm. P waves are inverted in II, III and aVF and upright in AVR. The PR interval is shorter compared to the RP interval. So, this is a regular narrow complex long RP tachycardia.

The differential diagnosis for long RP tachycardia with inverted P waves in the inferior leads are:


  • atrial tachycardia
  • atypical AV nodal reentry tachycardia (AVNRT)
  • persistent form of junctional reciprocating junctional tachycardia (PJRT)
  • junctional tachycardia


Reference:

Das and Zipes. 2012. Electrocardiography of arrhythmias : a comprehensive review. Elsevier PA

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