pseudo–A-A-V response can also occur when 1 : 1 VA

conduction
is absent during overdrive ventricular pacing (see Fig.
20.12), during
typical AVNRT with long HV intervals or short HA
intervals (whereby
atrial activation may precede ventricular activation), and
in patients
with a bystander BT. Replacing ventricular activation
with His activation
(i.e., characterizing the response as A-A-H or A-H
instead of A-A-V
or A-V, respectively) can be more accurate and can help
eliminate the
pseudo–A-A-V response in patients with AVNRT and
long HV intervals,
short HA intervals, or both.46
Pseudo–A-V response. A pseudo–A-V response can
occur with
an automatic AT when the maneuver is performed during
isoproterenol
infusion. Ventricular pacing with 1 : 1 VA conduction
can result in overdrive
suppression of the atrial focus, and isoproterenol can
enhance
junctional automaticity, so that an apparent A-V response
occurs.
Therefore, when ventricular pacing is performed during
an isoproterenol
 infusion, it is important to determine that the response
after cessation
of ventricular pacing is reproducible.28
A pseudo–A-V response can theoretically occur when AT
coexists
with retrograde dual AVN pathways or a bystander BT.
In such cases,
the last retrograde atrial complex would have an
alternative route for
anterograde conduction to the ventricle, other than the
one used for
retrograde VA conduction during ventricular pacing, thus
resulting in
an A-V response. However, clinical occurrence of these
theoretical scenarios
has not been observed, probably because of retrograde
penetration