{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T15:50:23Z","timestamp":1753890623933,"version":"3.41.2"},"reference-count":9,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,6,19]],"date-time":"2025-06-19T00:00:00Z","timestamp":1750291200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:p>Atrioventricular nodal reentrant tachycardia (AVNRT), the most common supraventricular tachycardia, occasionally present with transient ST-T changes mimicking ischemia, posing diagnostic challenges for patients. We report an 82-year-old woman with paroxysmal palpitations whose initial ECG demonstrated supraventricular tachycardia (154\u2005bpm) accompanied by dynamic ST-segment elevation and T-wave inversion in leads I, II, aVL, and aVF, while lead III remained unaffected. Repositioning electrodes away from the right radial artery pulsation resolved these deviations, confirming their artifactual origin. The electrophysiological study confirmed the diagnosis of atrioventricular nodal reentrant tachycardia (AVNRT), and successful radiofrequency catheter ablation was performed with no recurrence during 6-month follow-up. Notably, breath-holding during tachycardia exacerbated pulsation artifacts by altering hemodynamic forces, a phenomenon further validated through provocative Valsalva maneuvers. This case highlights that limb pulsation artifacts\u2014localized via Einthoven's triangle principles (sparing lead III)\u2014can mimic ischemic patterns, particularly under tachycardia and breath-holding. Clinicians should prioritize ECG artifact exclusion through lead adjustment and dynamic testing to avoid unnecessary invasive interventions.<\/jats:p>","DOI":"10.3389\/fcvm.2025.1612805","type":"journal-article","created":{"date-parts":[[2025,6,19]],"date-time":"2025-06-19T05:30:26Z","timestamp":1750311026000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["AVNRT complicated by Valsalva-exacerbated radial pulsation artifacts mimicking acute ischemia: a case report"],"prefix":"10.3389","volume":"12","author":[{"given":"Peng","family":"Li","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jingyu","family":"Kan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jingwen","family":"Ding","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chongkai","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Huaisheng","family":"Ding","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,6,19]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1161\/CIR.0000000000000311","article-title":"2015 ACC\/AHA\/HRS guideline for the management of adult patients with supraventricular tachycardia","volume":"133","author":"Page","year":"2016","journal-title":"Circulation"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1480","DOI":"10.1016\/0735-1097(96)00013-7","article-title":"Value of analysis of ST segment changes during tachycardia in determining type of narrow QRS complex tachycardia","volume":"27","author":"Riva","year":"1996","journal-title":"J Am Coll Cardiol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"383","DOI":"10.1016\/0735-1097(88)90410-x","article-title":"Significance of ST segment depression during paroxysmal supraventricular tachycardia","volume":"12","author":"Nelson","year":"1988","journal-title":"J Am Coll Cardiol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"772","DOI":"10.1001\/jamainternmed.2022.1796","article-title":"Is a shaking hand or a trembling heart producing changes in electrocardiogram findings?","volume":"182","author":"Zhai","year":"2022","journal-title":"JAMA Intern Med"},{"key":"B5","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1016\/j.jelectrocard.2010.12.162","article-title":"Electromechanical association: a subtle electrocardiogram artifact","volume":"45","author":"Aslanger","year":"2012","journal-title":"J Electrocardiol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"402","DOI":"10.1161\/CIRCULATIONAHA.117.032657","article-title":"Asymptomatic ST-segment\u2013elevation ECG in patient with kidney failure","volume":"137","author":"Sotananusak","year":"2018","journal-title":"Circulation"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1652","DOI":"10.1001\/jamainternmed.2021.6015","article-title":"Transient ST-segment elevation and QTc interval prolongation in a patient with persistent chest pain","volume":"181","author":"Zhai","year":"2021","journal-title":"JAMA Intern Med"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1007","DOI":"10.1001\/jamainternmed.2023.1728","article-title":"Spiked helmet sign in the Inferior leads","volume":"183","author":"Al Saiegh","year":"2023","journal-title":"JAMA Intern Med"},{"key":"B9","first-page":"45","article-title":"Relationship between the changes in heart rate and cardiac output during the Valsalva maneuver","volume":"537","author":"M\u00e4ntysaari","year":"1984","journal-title":"Acta Physiol Scand Suppl"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2025.1612805\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,19]],"date-time":"2025-06-19T05:30:26Z","timestamp":1750311026000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2025.1612805\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,19]]},"references-count":9,"alternative-id":["10.3389\/fcvm.2025.1612805"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2025.1612805","relation":{},"ISSN":["2297-055X"],"issn-type":[{"type":"electronic","value":"2297-055X"}],"subject":[],"published":{"date-parts":[[2025,6,19]]},"article-number":"1612805"}}