A pseudo-sinus rhythm due to bigeminal ectopy with the focus in the right superior pulmonary vein Marina Arai, MD, Seiji Fukamizu, MD, PhD, Rintaro Hojo,

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Presentation transcript:

A pseudo-sinus rhythm due to bigeminal ectopy with the focus in the right superior pulmonary vein Marina Arai, MD, Seiji Fukamizu, MD, PhD, Rintaro Hojo, MD, Masayasu Hiraoka, MD, PhD, FHRS HeartRhythm Case Reports Volume 4, Issue 11, Pages 553-555 (November 2018) DOI: 10.1016/j.hrcr.2018.07.015 Copyright © 2018 Heart Rhythm Society Terms and Conditions

Figure 1 A: Electrophysiological study confirms reconnection of the right superior pulmonary vein (RSPV), whereas the intracardiac electrogram indicates the presence of a reproducible bigeminal ectopy from the RSPV preceding the right atrial potentials. Although the first heartbeat (solid-line circle) is associated with atrioventricular conduction, the second heartbeat (dotted-line circle) is blocked. B: After reisolation of the RSPV, sinus rhythm has resumed, and a far-field potential of the RSPV is recorded in the right atrial catheter (*). CS = distal electrode pair of the coronary sinus catheter; RA = right atrium; SVC = superior vena cava. HeartRhythm Case Reports 2018 4, 553-555DOI: (10.1016/j.hrcr.2018.07.015) Copyright © 2018 Heart Rhythm Society Terms and Conditions

Figure 2 A: Catheter positions during reisolation of the right superior pulmonary vein (RSPV). A ring catheter in the RSPV is shown. Radiofrequency energy is applied at the site of earliest activation, that is, the roof of the RSPV. B: Twelve-lead electrocardiogram shows the presence of the pseudo-sinus rhythm in the first half of the examination; the true sinus rhythm appears right after 2 beats of atrial premature complexes with aberrant conduction. ABL = ablation catheter; CS = distal electrode pair of the coronary sinus catheter; RA = right atrium; SVC = superior vena cava. HeartRhythm Case Reports 2018 4, 553-555DOI: (10.1016/j.hrcr.2018.07.015) Copyright © 2018 Heart Rhythm Society Terms and Conditions