{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T08:27:47Z","timestamp":1773995267028,"version":"3.50.1"},"reference-count":11,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2023,4,21]],"date-time":"2023-04-21T00:00:00Z","timestamp":1682035200000},"content-version":"vor","delay-in-days":20,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,4,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The \u2018double fire\u2019 (DF) atrioventricular (AV) nodal response is a rare mechanism of two ventricular electrical activations following a single atrial beat due to dual AV node physiology. DF AV nodal response is often misdiagnosed and may lead to unnecessary invasive procedures.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary<\/jats:title>\n                  <jats:p>We describe a series of three cases with distinct clinical manifestations of DF AV nodal response: Patient 1 remained symptomatic after slow pathway modification for common AV nodal re-entry tachycardia. Patient 2 was misdiagnosed as having junctional bigeminy and developed heart failure with reduced left ventricle ejection fraction. Patient 3 was misdiagnosed as having atrial fibrillation (AF) and underwent two pulmonary vein isolation (PVI) procedures, without clinical improvement. All patients underwent an electrophysiological study (EPS) during which DF AV nodal response was confirmed and treated with radiofrequency ablation of the slow pathway. All patients were afterwards relieved from their symptoms.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion and conclusion<\/jats:title>\n                  <jats:p>DF AV nodal response is a rare electrophysiological phenomenon which can be clinically misinterpreted as other common arrhythmias, such as premature junctional bigeminy or AF and can contribute to tachycardia induced cardiomyopathy. Typical electrocardiogram- and EPS-derived findings can be indicative for DF AV nodal response. DF AV nodal response can be easily and effectively treated by slow pathway ablation.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytad162","type":"journal-article","created":{"date-parts":[[2023,4,21]],"date-time":"2023-04-21T10:54:17Z","timestamp":1682074457000},"source":"Crossref","is-referenced-by-count":1,"title":["The great deceiver: a case series of \u2018double fire\u2019 atrioventricular nodal response"],"prefix":"10.1093","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9109-8127","authenticated-orcid":false,"given":"S\u00edlvia","family":"Le\u00e3o","sequence":"first","affiliation":[{"name":"Department of Cardiology, Maastricht University Medical Centre , P. Debyelaan 25, 6229 HX Maastricht , The Netherlands"},{"name":"Department of Cardiology, Centro Hospitalar de Tr\u00e1s-os-Montes e Alto Douro , Vila Real , Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justin","family":"Luermans","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Maastricht University Medical Centre , P. Debyelaan 25, 6229 HX Maastricht , The Netherlands"},{"name":"Department of Cardiology, Radboud University Medical Center and Radboud Institute for Health Sciences , Nijmegen , The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8818-5964","authenticated-orcid":false,"given":"Kevin","family":"Vernooy","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Maastricht University Medical Centre , P. Debyelaan 25, 6229 HX Maastricht , The Netherlands"},{"name":"Department of Cardiology, Radboud University Medical Center and Radboud Institute for Health Sciences , Nijmegen , The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rachel","family":"ter Bekke","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Maastricht University Medical Centre , P. Debyelaan 25, 6229 HX Maastricht , The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dennis","family":"den Uijl","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Maastricht University Medical Centre , P. Debyelaan 25, 6229 HX Maastricht , The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4893-0824","authenticated-orcid":false,"given":"Dominik","family":"Linz","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Maastricht University Medical Centre , P. Debyelaan 25, 6229 HX Maastricht , The Netherlands"},{"name":"Department of Cardiology, Radboud University Medical Center and Radboud Institute for Health Sciences , Nijmegen , The Netherlands"},{"name":"Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen , Copenhagen , Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3938-6193","authenticated-orcid":false,"given":"Sevasti-Maria","family":"Chaldoupi","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Maastricht University Medical Centre , P. Debyelaan 25, 6229 HX Maastricht , The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2023,4,21]]},"reference":[{"key":"2023042810470352100_ytad162-B1","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/S0972-6292(16)30711-2","article-title":"Dual atrioventricular nodal pathways physiology: a review of relevant anatomy, electrophysiology, and electrocardiographic manifestations","volume":"14","author":"Mani","year":"2014","journal-title":"Indian Pacing Electrophysiol J"},{"key":"2023042810470352100_ytad162-B2","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1007\/s10840-018-0392-5","article-title":"A contemporary view of atrioventricular nodal physiology","volume":"52","author":"Markowitz","year":"2018","journal-title":"J Interv Card Electrophysiol"},{"key":"2023042810470352100_ytad162-B3","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1093\/europace\/euv056","article-title":"Dual atrioventricular nodal non-re-entrant tachycardia","volume":"18","author":"Peiker","year":"2016","journal-title":"Europace"},{"key":"2023042810470352100_ytad162-B4","first-page":"459","article-title":"New manifestations of dual A-V nodal pathways","volume":"2","author":"Wu","year":"1975","journal-title":"Eur J Cardiol"},{"key":"2023042810470352100_ytad162-B5","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1093\/eurheartj\/ehz467","article-title":"2019 ESC guidelines for the management of patients with supraventricular tachycardia","volume":"41","author":"Brugada","year":"2020","journal-title":"Eur Heart J"},{"key":"2023042810470352100_ytad162-B6","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1016\/S0972-6292(16)30715-X","article-title":"Dual AV nodal nonreentrant tachycardia resulting in inappropriate ICD therapy in a patient with cardiac sarcoidosis","volume":"14","author":"Karnik","year":"2014","journal-title":"Indian Pacing Electrophysiol J"},{"key":"2023042810470352100_ytad162-B7","first-page":"117","article-title":"Misinterpretation of dual atrioventricular nodal non-reentrant tachycardia as ventricular tachycardia and implantation of implantable cardioverter-defibrillator followed by inappropriate shocks","volume":"24","author":"T\u00fcrkmen","year":"2020","journal-title":"Anatol J Cardiol"},{"key":"2023042810470352100_ytad162-B8","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1007\/s00392-020-01596-y","article-title":"Outcomes in patients with dual antegrade conduction in the atrioventricular node: insights from a multicentre observational study","volume":"109","author":"Hartmann","year":"2020","journal-title":"Clin Res Cardiol"},{"key":"2023042810470352100_ytad162-B9","doi-asserted-by":"crossref","first-page":"1671","DOI":"10.1111\/j.1540-8159.2011.03218.x","article-title":"Dual atrioventricular nodal nonreentrant tachycardia: a systematic review","volume":"34","author":"Wang","year":"2011","journal-title":"Pacing Clin Electrophysiol"},{"key":"2023042810470352100_ytad162-B10","doi-asserted-by":"crossref","first-page":"752","DOI":"10.1046\/j.1540-8167.2003.02527.x","article-title":"Incessant nonreentrant tachycardia due to simultaneous conduction over dual atrioventricular nodal pathways mimicking atrial fibrillation in patients referred for pulmonary vein isolation","volume":"14","author":"Mansour","year":"2003","journal-title":"J Cardiovasc Electrophysiol"},{"key":"2023042810470352100_ytad162-B11","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1016\/j.hrthm.2021.09.031","article-title":"Identifying an appropriate endpoint for cryoablation in children with atrioventricular nodal reentrant tachycardia: is residual slow pathway conduction associated with recurrence?","volume":"19","author":"Zook","year":"2022","journal-title":"Heart Rhythm"}],"container-title":["European Heart Journal - 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