scholarly journals Discordant Pacing Manoeuvers and a Narrow QRS Tachycardia – What is the Tachycardia Mechanism?

2015 ◽  
Vol 01 (01) ◽  
pp. 32 ◽  
Author(s):  
Hussam Ali ◽  
Pierpaolo Lupo ◽  
Sara Foresti ◽  
Guido De Ambroggi ◽  
Gianluca Epicoco ◽  
...  
Keyword(s):  
Sinus Rhythm ◽  
Electrophysiological Study ◽  
Correct Diagnosis ◽  
Accessory Pathway ◽  
Paroxysmal Supraventricular Tachycardia ◽  
Atrioventricular Nodal Reentrant Tachycardia ◽  
Ventricular Pacing ◽  
Reentrant Tachycardia ◽  
Narrow Qrs ◽  
Atrial Activation

A 24-year-old female underwent an electrophysiological study because of recurrent episodes of drug-refractory, paroxysmal supraventricular tachycardia. During adrenergic stress, a narrow QRS tachycardia with eccentric atrial activation was reproducibly inducible. The response to premature ventricular extrastimulation during tachycardia suggested the presence of a slowly conducting accessory pathway. However, a comprehensive appraisal of the electrophysiological study delineated the tachycardia substrate as an atypical atrioventricular nodal reentrant tachycardia in the presence of a bystander nodofascicular pathway. Careful analysing of the basal pacing manoeuvers during sinus rhythm (para-Hisian and differential ventricular pacing) was crucial to establish the correct diagnosis and to avoid unnecessary left-side access to ablate this tachycardia.

scholarly journals Case Report: Wide-to-Narrow QRS Tachycardia in a 3-Month-Old Infant

2021 ◽  
Vol 8 ◽  
Author(s):  
Liang Zhao ◽  
Song Yan ◽  
Tao Wang ◽  
Yimin Hua ◽  
Kaiyu Zhou
Keyword(s):  
Case Report ◽  
Accessory Pathway ◽  
Paroxysmal Supraventricular Tachycardia ◽  
Reentrant Tachycardia ◽  
Bundle Branch Block ◽  
Atrioventricular Reentrant Tachycardia ◽  
Non Invasive ◽  
Narrow Qrs ◽  
Electrophysiological Examination ◽  
Concealed Accessory Pathway

Introduction: It is rare to find that wide QRS tachycardia automatically changes to narrow QRS tachycardia, and it is more difficult to clarify the mechanism.Case Report: A 3-month-old infant with recurrent paroxysmal supraventricular tachycardia underwent transesophageal cardiac electrophysiological examination. The wide QRS tachycardia was induced by atrial RS2 stimulation, and it soon changed to narrow QRS tachycardia automatically. By the accurate measurement of esophageal lead, it was found that the electrocardiogram changes completely conform to Coumel law. The mechanism of wide and narrow QRS tachycardia was orthodromic atrioventricular reentrant tachycardia with or without ipsilateral functional bundle branch block, and the accessory pathway was defined as the left free wall-concealed accessory pathway.Conclusion: Transesophageal cardiac electrophysiological examination can reveal some special electrophysiological phenomena, and its non-invasive nature is especially suitable for infants.

Abstract 1541: Atypical Atrioventricular Nodal Reentrant Tachycardia with Anterior Retrograde Slow Pathway: Incidence, Electrophysiological Characteristics and Effect of Slow Pathway Ablation

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Kiyoshi Otomo ◽  
Yasutoshi Nagata ◽  
Hiroshi Taniguchi ◽  
Kikuya Uno ◽  
Yoshito Iesaka
Keyword(s):  
Anterior Part ◽  
Slow Pathway ◽  
Atrioventricular Nodal Reentrant Tachycardia ◽  
Av Block ◽  
Ventricular Pacing ◽  
Reentrant Tachycardia ◽  
Slow Pathway Ablation ◽  
Atrial Activation ◽  
The Right ◽  
Second Degree

BACKGROUND: Atypical AV nodal reentrant tachycardias (AVNRT) usually exhibit earliest retrograde atrial activation (ERAA) at the right posteroseptum (Rt-PS) or proximal coronary sinus (PCS). However, previous studies have shown that atypical AVNRT could rarely exhibit ERAA at the right anteroseptum (Rt-AS). The purpose of this study was to elucidate the incidence, characteristics and effect of slow pathway (SP) ablation in atypical AVNRT with an anterior retrograde SP. METHODS: The electrophysiological and ablation data were reviewed in 360 AVNRTs induced in 340 consecutive patients. Atypical AVNRT was differentiated from typical form by a longer H-A interval during ventricular pacing at the tachycardia cycle length (TCL) (HAp: =/>70ms), and evidences for a lower common pathway (LCP), including second-degree AV block without tachycardia interruption, HAp longer than the HA interval during tachycardia (HAt). Atypical AVNRTs were classified into two types; the posterior type with ERAA at the Rt-PS or PCS; and anterior type with ERAA at the Rt-AS. RESULTS: In a total of 360 AVNRTs, there were 300 typical (83%) and 60 atypical forms (17%). Among the 60 atypical forms, 51 (14%) were classified into the posterior type, while the remaining 9 (3%) were classified into the anterior type. The anterior type of atypical AVNRT (TCL: 322+/−37ms) exhibited ERAA at the Rt-AS during the tachycardia and ventricular pacing, shorter A-H interval (162+/−39ms), longer HAt (167+/−40 ms), longer HAp (184+/−53ms), and evidences for a LCP, including a second-degree AV block during the tachycardia (n=4) and HAt being shorter than the H-Ap (n=9). All posterior types of atypical AVNRT were rendered non-inducible after an ablation to the ERAA site. In anterior type, the conventional SP ablation at the Rt-PS did not eliminate any of the 9 tachycardias; however, ablations at the right midseptum eliminated 7 (78%) of the 9 anterior types of atypical AVNRT. CONCLUSION: Atypical AVNRT with an anterior retrograde SP was observed in 3% of all AVNRTs. Conventional Rt-PS ablation was ineffective; and the midseptal ablation was modestly effective in this entity. The tachycardia circuit of the anterior type might be deviated to more anterior part of the Koch’s triangle than that of the posterior type.

scholarly journals Safety and efficacy of electrophysiological studies and radiofrequency ablation of paroxysmal supraventricular tachycardia

2020 ◽  
Vol 4 (3) ◽  
pp. 818-821
Author(s):  
Abdul Khaliq Monib ◽  
Rajesh Nepal ◽  
Sahadeb Prasad Dhungana ◽  
Roshan Raut
Keyword(s):  
Radiofrequency Ablation ◽  
Electrophysiological Study ◽  
Accessory Pathway ◽  
Study Data ◽  
Female Dominance ◽  
Paroxysmal Supraventricular Tachycardia ◽  
Safety And Efficacy ◽  
Efficacy Analysis ◽  
Early Results ◽  
Reentry Tachycardia

Introduction: Cardiac electrophysiological study (EPS) and radiofrequency ablation (RFA) is an established mode of treatment either as first-line or for drug-refractory arrhythmias. Our center has recently started this service under 2-D mapping outside Kathmandu valley Objective: The aim was to evaluate the safety and efficacy of EPS and RFA for paroxysmal supraventricular tachycardias (PSVT). Methodology: This is an observational prospective study carried out in the Cardiac Unit of Nobel medical college, Biratnagar, Nepal. All cases diagnosed to have PSVT based on electrocardiogram or Holter recordingfromAugust 2018 and May2019wereincluded in the study. Data on clinical profile and findings of EPS were recorded. Fifty-nine cases were chosen for safety and efficacy analysis, using SPSS statistical software version 19. Results: There were 59 patients, 28(47.5%) males, and 31(52.5%) females. The mean age was 38.2 ± 15.9 years. Fifty-three patients underwent RFA while 6 patients underwent only EPS. In the Atrioventricular nodal reentry tachycardia (AVNRT) group, there was female dominance (P=0.2) while in Atrioventricular reentry tachycardia (AVRT) group, there was no significant gender difference (p=0.4). Left-sided pathway (68%) was more common in the AVRT group. Among the left accessory pathway (AP), left lateral AP (44%) was more common. No major complications including death were noted. Two cases of successful ablation relapsed in one month follow up. Conclusions: Early results of this small study in patients with PSVT confirm the efficacy and safety of RFA in newly established electrophysiology (EP) laboratory.

Supraventricular Tachycardia

2020 ◽  
Author(s):  
Laurence M. Epstein ◽  
Saurabh Kumar
Keyword(s):  
Atrial Flutter ◽  
Supraventricular Tachycardia ◽  
Cardiac Tissue ◽  
Accessory Pathway ◽  
Maze Procedure ◽  
Atrioventricular Nodal Reentrant Tachycardia ◽  
Reentrant Tachycardia ◽  
Inappropriate Sinus Tachycardia ◽  
Atrioventricular Reentrant Tachycardia ◽  
Supraventricular Tachycardias

Supraventricular tachycardias (SVTs) comprise a group of usually benign arrhythmias that originate from cardiac tissue at or above the His bundle. SVTs include inappropriate sinus tachycardia, atrial tachycardias (ATs), atrial flutter (AFL), junctional tachycardia, atrioventricular nodal reentrant tachycardia (AVNRT), and forms of accessory pathway–mediated reentrant tachycardias (atrioventricular reentrant tachycardia [AVRT]). Although mostly benign, symptoms can be debilitating, in the form of palpitations, shortness of breath, chest discomfort, dizziness, and/or syncope; rarely, SVTs can result in cardiomyopathy due to incessant arrhythmia. This review covers the epidemiology, diagnosis, management, and classification of SVTs.  This review contains 14 figures, 17 tables, and 61 references. Keywords: Supraventricular tachycardia, cardioversion, arrhythmia, atrial flutter, atrial fibrillation, Wolff-Parkinson-White syndrome, MAZE procedure, catheter ablation

scholarly journals Electrophysiological Studies in Patients with Pulmonary Hypertension: A Retrospective Investigation

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Dirk Bandorski ◽  
Jörn Schmitt ◽  
Claudia Kurzlechner ◽  
Damir Erkapic ◽  
Christian W. Hamm ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Atrial Flutter ◽  
Electrophysiological Study ◽  
Atrioventricular Nodal Reentrant Tachycardia ◽  
Reentrant Tachycardia ◽  
Group 4 ◽  
Electrophysiological Studies ◽  
Group 5 ◽  
Group 2 ◽  
Ventricular Tachycardias

Few studies have investigated patients with pulmonary hypertension and arrhythmias. Data on electrophysiological studies in these patients are rare. In a retrospective dual-centre design, we analysed data from patients with indications for electrophysiological study. Fifty-five patients with pulmonary hypertension were included (Dana Point Classification: group 1: 14, group 2: 23, group 3: 4, group 4: 8, group 5: 2, and 4 patients with exercised-induced pulmonary hypertension). Clinical data, 6-minute walk distance, laboratory values, and echocardiography were collected/performed. Nonsustained ventricular tachycardia was the most frequent indication (n=15) for an electrophysiological study, followed by atrial flutter (n=14). In summary 36 ablations were performed and 25 of them were successful (atrial flutter 12 of 14 and atrioventricular nodal reentrant tachycardia 4 of 4). Fluoroscopy time was 16±14.4 minutes. Electrophysiological studies in patients with pulmonary hypertension are feasible and safe. Ablation procedures are as effective in these patients as in non-PAH patients with atrial flutter and atrioventricular nodal reentrant tachycardia and should be performed likewise. The prognostic relevance of ventricular stimulations and inducible ventricular tachycardias in these patients is still unclear and requires further investigation.

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