41 yr old lady Recurrent episodes of tachycardia Sometimes terminated by deep breathing Normal echo...
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41 yr old lady Recurrent episodes of tachycardia Sometimes terminated by deep breathing Normal echo Inputs from Ulhas Pandurangi
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Transcript of 41 yr old lady Recurrent episodes of tachycardia Sometimes terminated by deep breathing Normal echo...
41 yr old ladyRecurrent episodes of tachycardia
Sometimes terminated by deep breathing
Normal echo
Inputs from Ulhas Pandurangi
The features of the “GOOGLY” 1. Intermittent A-V Block
2. Long RP during 1:1 AV relationship
3. Inverted and narrow ‘P’ waves in inferior leads
4. VAV response on VOD
Hence “GOOGLY” seems to be Atypical AVNRT
( I wear Helmet, always, when Yash delivers)
Why should deep inspiration terminate tachycardia: The manoeuver - Muller is still mulling over
Normal ECG. PES (basal trainS1 + S2) from CS
Blocked His extrasystole
Tachy initiation- RV stimuli initiate tachy with 2:1 AV conduction, followed by 1:1 LBBB tachycardia – Atrial tachycardia or Atypical AVNRT
Atrial activation sequence during ventricular pacing is similar to that during tachycardia ? Atrial tachycardia originating near posteroseptal region or atypical AVNRT
Termination of LBBB, 1:1 AV tachycardia without ‘A’: AT or Atypical AVNRT
HIS PVC did not affect tachycardia – Does not help much
Very early PVC did not affect tachycardia – ORT unlikely
VAV response at the end of entraining VOD - AT ruled out, Atypical AVNRT ruled inAlso PPI-TCL more than 100 ms
300 ms425 ms
75 ms 250 ms
Easy inducibility by narrow QRS tachycardia by ventricular pacing – A clue for Atypical AVNRT, especially when P waves are inverted and narrow ( even in the presence of AV Block)
S2 initiated tachycardia Atrial activation sequence by S2 similar to that during tachycardia
The AV block is infra-His
Deep inspiration -2:1 to 1:1 AV conduction followed by termination during deep inspiration block in the retrograde slow pathway
Deep inspiration again- Vagally mediated tachy termination
Adenosine Both AH ( ) and HA ( ) prolong prior to termination in the retrograde limb.
RF site Activation mapping during tachy. A earliest in rfD
RF energy- Just above CS os. Tachy terminates retrogradely
After ablation – No VA conduction
Final diagnosis
Atypical AVNRT (Fast-slow for the “splitters”) with 2:1 AV conduction
Successful RF ablation of retrograde limb
No retrograde fast pathway conduction
