“Frog Sign” in Atrioventricular Nodal Reentrant Tachycardia

An 83-year-old man was evaluated for frequent palpitations. During an episode, examination of the neck revealed rapid and regular pulsations with bulging of the internal jugular veins, shown in a video. A 12-lead electrocardiogram showed a regular, narrow-complex tachycardia. An 83-year-old man was evaluated for frequent palpitations. During an episode, examination of the neck revealed rapid and regular pulsations with bulging of the internal jugular veins (see Video 1). A 12-lead electrocardiogram was obtained and showed a regular, narrow-complex tachycardia, with narrow P waves deforming the terminal QRS complex (Panel A, arrowheads). The P wave is negative in the inferior leads (forming a pseudo-S wave) and positive in lead V 1 (forming a pseudo-r′ wave). On the application of pressure to the carotid sinus, the tachycardia and the bulging of the internal jugular veins were resolved (Panel B, asterisk, . . .