Recurrent Adenosine-Sensitive Supraventricular Tachycardia Associated With the Menstrual Cycle in a Middle-Aged Woman: A Case Report of Typical Atrioventricular Nodal Reentrant Tachycardia (AVNRT)

Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common cause of paroxysmal supraventricular tachycardia in adults and frequently presents with sudden-onset palpitations and regular narrow-complex tachycardia. Although generally considered benign, recurrent symptomatic episodes often lead to repeated emergency department visits and reduced quality of life, warranting definitive therapy. We report the case of a 42-year-old woman who presented with several hours of palpitations and was found to have a regular narrow-complex tachycardia at approximately 200 beats per minute without visible P waves. Subtle pseudo r' deflections in lead V1 and pseudo S waves in the inferior leads were noted, consistent with typical slow-fast AVNRT. Vagal maneuvers were ineffective, and intravenous adenosine at a dose of 12 mg resulted in transient atrioventricular block followed by the prompt restoration of sinus rhythm. Post-conversion electrocardiography demonstrated normal atrioventricular conduction without evidence of ventricular preexcitation, and transthoracic echocardiography confirmed the absence of structural heart disease. The patient reported multiple similar episodes over the preceding months, frequently occurring around the onset of menstruation, suggesting a potential influence of hormonal fluctuations on arrhythmia susceptibility. Given the recurrent and symptomatic nature of the episodes, she was referred for electrophysiological study and catheter ablation, which is recommended as first-line definitive therapy for AVNRT. This case highlights the classic electrocardiographic features and adenosine sensitivity of AVNRT, supports early referral for curative ablation in recurrent cases, and draws attention to possible hormonal modulation as a trigger for supraventricular tachycardia in susceptible patients.