A Rare Mechanism of Tachycardia and Aberrancy

Key Teaching Points•A dual atrioventricular (AV) nodal response is a rare cause of arrhythmias but can be diagnosed by a detailed evaluation of the electrocardiogram at rest and during exercise.•A dual AV nodal response can cause cardiomyopathy, which can be totally reversible after treatment of the arrhythmia.•Ablation of the slow pathway is an excellent way to treat the arrhythmia. •A dual atrioventricular (AV) nodal response is a rare cause of arrhythmias but can be diagnosed by a detailed evaluation of the electrocardiogram at rest and during exercise.•A dual AV nodal response can cause cardiomyopathy, which can be totally reversible after treatment of the arrhythmia.•Ablation of the slow pathway is an excellent way to treat the arrhythmia.