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We present a case of paroxysmal atrioventricular block with atrial pacemaker shift, focusing on the change of P-wave morphology.27-year-old male with incessant palpitations and reduced ejection fraction presents for diagnostic electrophysiology study. ECG shows a long RP tachycardia. Permanent junctional reciprocating tachycardia is diagnosed on EP study with successful ablation of posteroseptal accessory pathway.Larger tip cryoablation catheters can dampen the signal at the distal tip reducing the resolution of mapping of supero paras
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