Normal echo Inputs from Chandrashekhar

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Presentation transcript:

Normal echo Inputs from Chandrashekhar 4 year old girl Recurrent SVT episodes @ 200/min Breakthroughs on propafenone Normal echo Inputs from Chandrashekhar

Tachy induced during catheter insertion- D/D?: ORT/AVNRT/AT

Tachy induced by APDs- analyse. CS56 A earliest, A not seen in His Tachy induced by APDs- analyse. CS56 A earliest, A not seen in His. With RBBB there is some increase in the TCL ( ) are equal. Strongly suggests a right AT with ORT.

Route of VA conduction? AV node/septal AP

Another induction-analyse. SVT with LBBB

Intracardiacs- D/D at this stage Intracardiacs- D/D at this stage? ORT with LBBB most likely in view of earlier data

Any further insight? No change in TCL with LBBB

Intracardiacs. No change in TCL with LBBB

Diagnosis clinched. Yes, spontaneus termination after A Diagnosis clinched? Yes, spontaneus termination after A. Or any further manouever needed?

Interpret- His refractory VPD during NCT No effect is seen

RFD at the CS os - A is late at CS OS

At IAS adjacent to the apex of the triangle of Koch At this location RF D shows continuous electrical activity with RFD A earlier

This was the earliest ‘A’ (see next slide). Analyse the RF signal. RF D A is earliest. A small His is seen in rfD. This was the earliest ‘A’ (see next slide).

LAO 40. This was the site. What next? We can map the aortic sinuses

What about this site? RF D showing better signals even earlier A

RF site- RAO 30

RF site- LAO 40

RF energy…. Tachy termination in AP

Aortic root angio after ablation- LAO 40. No AR

Final trace- No VA conduction