A 68-year-old businessman was at work in his office when he developed a sensation of pounding in his lower anterior chest. He had experienced five similar episodes in the past 4 years, that lasted 20-60 minutes. All subsided spontaneously, except one 2 years earlier, when he went to another hospital where he received an IV injection and was put on sotalol. He has no risk factors for CAD and leads a very active life without symptoms:

• Supraventricular tachycardia, 170/min
• AV Nodal Re-entrant Tachycardia (AVNRT)
• ST abnormality, consider possible ischemia

As vagal stimulation maneuvers were unsuccessful, the patient was given a bolus IV injection of Adenosine and sinus rhythm was restored. The following ECG was recorded a few minutes later. There is no longer ST depression. The tracing is normal.

During the following year the patient had 4 episodes of supraventricular tachycardia, that lasted up to 13 hours and required intravenous medication. He eventually gave informed consent for EP studies and ablation. During the procedure, typical AVNRT was induced by catheter manipulation and programmed atrial stimulation The patient underwent successful slow pathway ablation without complications.