Christopher F. Liu et al. JACEP 2016;j.jacep

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Christopher F. Liu et al. JACEP 2016;j.jacep.2016.09.013 Adenosine Block of Eccentric VA Activation Due to AV Nodal Conduction (A) Ventricular pacing demonstrates eccentric atrial activation, earliest at the proximal–mid coronary sinus. Adenosine (ADO) results in VA block (arrow). (B) During SVT, ventricular entrainment demonstrates the identical eccentric VA activation sequence and a V-A-V response, ruling out atrial tachycardia. The corrected PPI–TCL was 136 ms, consistent with a diagnosis of AVNRT with a left-sided retrograde fast atrionodal input. (C) Fluoroscopic position of diagnostic catheters. Note that the bipolar electrodes showing earliest retrograde activation (red circle) reflect left-sided activation. AV = atrioventricular; AVNRT = atrioventricular nodal re-entrant tachycardia; CS = coronary sinus; HB = His bundle; HRA = high right atrium; LAO = left anterior oblique; PPI = post-pacing interval; RV = right ventricle; RVA = right ventricular apex; SVT = supraventricular tachycardia; TCL = tachycardia cycle length; VA = ventriculoatrial. Christopher F. Liu et al. JACEP 2016;j.jacep.2016.09.013 American College of Cardiology Foundation