FIGURE 86.2 Supraventricular tachycardia due to atrioventricular accessory connection This is SVT at nearly 300 BPM Retrograde P waves are seen immediately following the QRS complex suggesting atrioventricular re-entrant tachycardia mediated by an atrioventricular accessory connection, such as Wolff–Parkinson–White Ventricular pre-excitation is not seen in tachycardia, but rather in sinus rhythm This tachycardia should break with Valsalva maneuvers or adenosine