Peculiar Electrocardiographic Feature Accurately Localizing an Unusual Case of Permanent Junctional Reciprocating Tachycardia

Permanent junctional reciprocating tachycardia (PJRT) is an uncommon form of supraventricular tachycardia due to an accessory pathway with slow retrograde conduction that is mostly localized in the posteroseptal area. The standard ECG shows long RP tachycardia with negative P waves in the inferior leads and positive P waves in leads I and aVL. We report a case of PJRT in a 31-year-old lady with incessant long RP tachycardia displaying negative P waves not only in the inferior leads but also in leads I and aVL. The accessory pathway was localized in the left posteroseptal region and managed successfully with radiofrequency catheter ablation.