Tracing from a patient with Wolff–Parkinson–White (WPW) and documented supraventricular tachycardia. The first two cycles are preexcited and a 12-lead.

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Presentation transcript:

Tracing from a patient with Wolff–Parkinson–White (WPW) and documented supraventricular tachycardia. The first two cycles are preexcited and a 12-lead ECG suggested a septal pathway conducting anterogradely. Earliest ventricular activation in sinus rhythm is at the proximal coronary sinus electrode (CSp) positioned near the orifice of the coronary sinus. An atrial extrastimulus (S) blocks the pathway and starts supraventricular tachycardia. However, earliest retrograde atrial activity is at the distal coronary sinus electrogram. In this patient, complete mapping revealed that the "culprit" accessory pathway was a concealed left lateral pathway and the manifest accessory pathway was of no clinical significance. Ablation of this pathway would have served no purpose. 1, 2, and V1, surface ECG; HBE, His bundle electrogram. Source: Analysis of Complex Electrophysiologic Data, Clinical Electrophysiology Review, 2e Citation: Klein GJ, Prystowsky EN. Clinical Electrophysiology Review, 2e; 2016 Available at: http://accesscardiology.mhmedical.com/DownloadImage.aspx?image=/data/books/1787/kleincer_ch1_f002.png&sec=120738715&BookID=1787&ChapterSecID=120738704&imagename= Accessed: October 29, 2017 Copyright © 2017 McGraw-Hill Education. All rights reserved