Middle age female came with palpitation, ECG showing narrow complex tachycardia

A 55 -years old female came with history  of palpitation of one hour duration. She was a known case of diabetes mellitus and hypertension since last 10 years and was on medical treatment for the same. ECG of the patient done in the emergency department is shown below.

ECG during the episode of  tachycardia

ECG is showing narrow complex regular tachycardia at rate 180 per minute, normal axis, no visible P wave seen, there were no ST-T wave changes seen. So the ecg diagnosis of the patient was kept narrow complex, regular, short RP (as P wave not visible ) tachycardia with differential diagnosis being AVNRT, AVRT, Atrial tachycardia.

Patient was given injection adenosine following which her tachycardia subsided.

ECG after giving injection adenosine

ECG is showing normal sinus rhythm at rate 114 beats per minute, normal axis, no pre-excitation visible.

Patient underwent electrophysiological study which showed dual AV nodal physiology. Patient underwent successful slow pathway ablation and was discharged in stable condition.

Lets discuss how to approach in a patient with Short RP regular, narrow complex tachycardia.

Thank you.