A diagnostic challenge of dual atrioventricular nodal nonreentrant tachycardia revealed by ambulatory electrocardiographic monitoring: a case report

By
Zhiqin Ma
Jianzhou Tian
Ping Yuan
Jun Shen
May 8, 2026
0 min

Frontiers In Cardiovascular Medicine

Overview

This case study highlights the diagnostic challenges of dual atrioventricular nodal nonreentrant tachycardia (DAVNNT) and the importance of ambulatory electrocardiographic monitoring in its identification. The findings suggest that careful analysis of ECG and Holter data can lead to a timely diagnosis before invasive procedures are necessary.

Background

DAVNNT is a rare arrhythmia characterized by simultaneous conduction through both fast and slow pathways of the atrioventricular node, leading to double ventricular activation. Its variable electrocardiographic manifestations often mimic other supraventricular arrhythmias, making it frequently overlooked. Understanding and recognizing DAVNNT is crucial for appropriate management and treatment, particularly in symptomatic patients.

Data Highlights

No numerical data available in the article.

Key Findings

The patient presented with cough and chest tightness, initially diverting attention from cardiac evaluation.
Initial ECGs suggested sinus rhythm with junctional or atrial ectopic activity.
24-hour Holter monitoring revealed absence of a strict 1:1 relationship between P waves and QRS complexes.
Findings included recurrent short and long PR intervals and fast- and slow-pathway Wenckebach conduction.
The case emphasizes the diagnostic value of noninvasive monitoring in identifying DAVNNT.

Clinical Implications

Healthcare professionals should consider DAVNNT in patients presenting with palpitations and associated symptoms, especially when initial ECG findings are inconclusive. Ambulatory monitoring can provide critical insights that may lead to a correct diagnosis and timely intervention.

Conclusion

This case underscores the importance of thorough electrocardiographic evaluation in diagnosing DAVNNT, highlighting that noninvasive methods can effectively identify this challenging arrhythmia.