Introduction Atrioventricular nodal re-entrant tachycardia (AVNRT) is the most common regular Paroxysmal Supraventricular Tachycardia. Although generally considered a benign arrhythmia in majority of the cases, recurrent AVNRT in elderly can lead towards tachycardia-induced ventricular dilation and dysfunction.

Case Presentation 84-year-old gentleman with underlying Type 2 Diabetes Mellitus, CKD Stage 4 and Bronchial Asthma with infrequent episodes of palpitation since the age of 50 was referred for continuation of care in November 2022. He has good functional status with NYHA Class 1. His baseline ECG revealed SR with HR 60bpm with bifascicular block. His Echo showed preserved LV systolic function with EF 52%. In February 2023, he first presented with sudden onset of palpitation. A diagnosis of SVT with aberrancy with HR 140bpm was made likely Typical Slow Fast AVNRT with aVL notch and pseudo s wave in Lead 2. Adenosine rhythm strip confirmed the diagnosis of dual nodal tachycardia with PR jump and AV nodal echo. Trop T and NT-Pro BNP were negative. He opted for medical therapy. Since then, he had 3 monthly visits with similar diagnosis. His functional status started to reduce to NYHA Class 2. In June 2024, upon our re-assessment, noted his NT- Pro BNP was raised to 3023pg/mL. Echo revealed EF of <30%. HF GDMT was initiated and referral for ablation was made.

Discussion Tachycardia-Induced Cardiomyopathy Syndrome (TICS) is characterized by reversible ventricular dilation and systolic dysfunction due to sustained or frequent supraventricular or ventricular arrhythmias. It is usually associated with atrial arrhythmias and frequent ventricular ectopy. However, association of AVNRT with TICS has only been reported in the literature as case reports as most of AVNRT is well tolerated in young patient. However, in regards of advanced age, multiple co-morbid and degenerative conductive disease, incident of AVNRT leading to TICS can be underdiagnosed.

Conclusion Although long term complication is rare with AVNRT, with advance age and degenerative conductive disease, recurrent episodes of AVNRT might lead to TICS. Thus in this situation, vigilant follow-up and re-evaluation are required. Ablation and optimization of HF GDMT remains the mainstay of treatment with this complication.