# A Case of Atrioventricular Nodal Re-entrant Rhythm

## TL;DR

A 60-year-old man with liver disease experienced a heart rhythm issue that was resolved with pacing, prompting investigation into its cause.

## Contribution

The paper presents a clinical case highlighting the diagnosis and management of an unusual heart rhythm.

## Key findings

- The patient's rhythm was easily terminated with ventricular overdrive pacing.
- The ECG showed transitions between a borderline R–P narrow complex rhythm and sinus rhythm.
- The case raises questions about the underlying mechanism of the observed rhythm.

## Abstract

A 60-year-old male with a history of decompensated chronic liver disease and resolving hepatic encephalopathy was transferred for further evaluation following a witnessed episode of prolonged asystole. The patient’s admission electrocardiogram showed spontaneous transitions between a borderline R–P narrow complex rhythm and sinus rhythm. The rhythm was observed to be easily terminated with ventricular overdrive pacing via the temporary catheter. We questioned what the mechanism of the rhythm may be.