A 25 year old woman is referred to the electrophysiology clinic for frequent long episodes of palpitations for a few years. Her echocardiogram shows LVEF of 45% with global hypokinesis. Her ECG is shown below: 

• Supraventricular tachycardia likely Permanent Junctional Reciprocating Tachycardia (PJRT), ventricular rate 123/min 

 Comment: Permanent Junctional Reciprocating Tachycardia (PJRT) is a type of supraventricular tachycardia causing Atrioventricular reentrant tachycardia that is characterized by negative P wave axis in inferior leads (annotated as Ps) and long RP interval. Unlike the WPW accessory pathway, PJRT accessory pathway conducts slowly. Due to the incessant characteristics of PJRT it can lead to tachycardia induced cardiomyopathy.  

Below is her ECG after ablation of accessory pathway:

• Normal sinus rhythm, ventricular rate 71/min