Patient in her sixties had a dual chamber pacemaker implanted in 2015 because of brady-tachy syndrome.

She experienced a syncope and had her pacemaker interrogated at the first heart aid. Below is the EGM during syncope. 

What is the arrhythmia?

Physician advice: 
Non
Trace category: 
EGM
Device/Field: 
PM
Company: 
Medtronic

Ventricular tachycardia

AVNRT:
- PAC (1st AR) with long PR suggests refractory fast pathway and depolarisation of the vemtricles through the slow pathway
- 1-to-1 A & V association, we see only ventricular markers but there are clear atrial deflectiins within the PVAB (note that the EGM is atrial)
 
Since we got her on verapamil we saw no recurrences.