Irregular wide QRS complex tachycardia in a patient with pulmonary hypertension: What is the mechanism? Abigail Louise D. Te, MD, Fa-Po Chung, MD, Yenn-Jiang.

Slides:

Advertisements

Similar presentations

Abnormal epicardial electrophysiologic substrate in patients with early repolarization pattern and reduced left ventricular systolic function: A report.

Advertisements

Kim H. Chan, MBBS, PhD, Raymond W. Sy, MBBS, PhD

Pulmonary arterial pressure sensing in a patient with left ventricular assist device during ventricular arrhythmia Jill R. Harris, MSN, ACNP-C, CNS,

Successful use of bivalirudin in place of heparin infusion for pulmonary vein isolation using a cryoballoon catheter in a patient with heparin allergy

Radiofrequency ablation of premature ventricular contractions originating from the aortomitral continuity localized by use of a novel noninvasive epicardial.

Gender differences in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy: Clinical manifestations, electrophysiological properties,

Incessant bundle branch reentrant ventricular tachycardia in a patient with corrected transposition of the great arteries Ken Kato, MD, Daigo Yagishita,

Successful ablation of premature ventricular contractions originating from the inferoseptal process of the left ventricle using a coronary sinus approach

A subtype of idiopathic ventricular fibrillation and its relevance to catheter ablation and genetic variants Takahiko Nishiyama, MD, Yoshiyasu Aizawa,

Volume 15, Issue 1, Pages (January 2018)

Premature ventricular contractions with two QRS morphologies originate from one focus in great cardiac vein Juan Ma, MD, Ke-Xiang Wu, MD, Yu-Bin Wang,

A case of paroxysmal atrioventricular block–induced cardiac arrest

Successful catheter ablation of recipient left ventricular tachycardia 26 years after heterotopic heart transplantation Mikael Laredo, MD, Shaida Varnous,

Challenges in the diagnosis and management of idiopathic ventricular fibrillation Jonathan Lipton, MD, PhD, George J. Klein, MD, Raymond W. Sy, MBBS,

A case of scar-related ventricular tachycardia demonstrating termination with nonglobal capture at the site of concealed entrainment with dual slow conduction.

Quinidine effective for the management of ventricular and atrial arrhythmias associated with Brugada syndrome Laura Halperin, BSc, Greg Mellor, MD, Mario.

Recurrent idiopathic polymorphic ventricular tachycardia/ventricular fibrillation successfully treated by cardiac sympathetic denervation Faisal Matto,

Limitations of 12-lead electrocardiogram wide complex tachycardia algorithms in a patient with left atrial flutter and large myocardial infarction Carlos.

Atrioventricular block and pause-dependent torsade de pointes

Left ventricular tachycardia ablation in a toddler via a transapical approach: A new tool for the armamentarium Daniel Benhayon, MD, FHRS, John Cogan,

Atrial fibrillation originating from recipient left atrium after an orthotopic heart transplantation Auroa Badin, MD, Jaret Tyler, MD, FHRS, Steven J.

Successful demonstration of the detailed connection between the twin atrioventricular nodes and sling in a patient with asplenia syndrome Hitoshi Mori,

Isolation of the conduction between the Marshall bundle and distal coronary sinus and the entire coronary sinus for an atrial tachycardia after catheter.

Bradley D. Brochu, MD, Ahmed Abdi-Ali, MD, Jeffrey Shaw, MD, F

Pulmonary arterial pressure sensing in a patient with left ventricular assist device during ventricular arrhythmia Jill R. Harris, MSN, ACNP-C, CNS,

HeartRhythm Case Reports

Multiple monomorphic ventricular tachycardias in a structurally normal heart: A case report Daljeet Kaur Saggu, MD, DM, Mandar Shah, MD, DNB, Abhijeet.

Successful catheter ablation using real-time ultrasound-assisted 3-D electroanatomical mapping system for atrioventricular accessory pathway in a 1-year-old.

Isolated, premature ventricular complex–induced right ventricular dysfunction mimicking arrhythmogenic right ventricular cardiomyopathy Antonio Berruezo,

Finding the right pathway is the key to success

Adenosine-sensitive atrial tachycardia originating from the anterior mitral annulus Dai Inagaki, MD, Rintaro Hojo, MD, Seiji Fukamizu, MD, PhD, Harumizu.

A case of successful termination of an atrial tachycardia ablated from the pulmonary artery during rapid ventricular pacing Toshiya Kurotobi, MD, PhD,

Single-catheter validation of bidirectional block during atrial flutter ablation Piotr Futyma, MD, Marian Futyma, MD, PhD, Konrad Dudek, MD, Piotr Kułakowski,

Focal atrial fibrillation presenting in the origin of atrial tachycardia Chin-Yu Lin, MD, Yenn-Jiang Lin, MD, Fa-Po Chung, MD, Shih-Ann Chen, MD HeartRhythm.

A case of ventricular fibrillation triggered by ventricular premature depolarizations exiting from different sites of the Purkinje network Stavros E.

Unconventional warfare: Successful ablation of ventricular tachycardia by direct ventricular puncture in a patient with double mechanical heart valves

Dual intraventricular response after cardiac resynchronization

Successful use of bivalirudin in place of heparin infusion for pulmonary vein isolation using a cryoballoon catheter in a patient with heparin allergy

Ablation of parahisian ventricular focus

Atrial Tachycardia in a Patient With Fabry’s Disease

Bundle branch reentry: A novel mechanism for sustained ventricular tachycardia in Chagas heart disease Alvaro V. Sarabanda, MD, PhD, Wagner L. Gali,

Mapping of a postinfarction left ventricular aneurysm–dependent macroreentrant ventricular tachycardia Elad Anter, MD, Jianqing Li, MD, Cory M. Tschabrunn,

An unusual cause of lone atrial fibrillation in a young female subject due to a rapid- cycling focal atrial trigger Shankar Baskar, MD, Mehran Attari,

Nonreentrant proximal fascicular ventricular tachycardia, with normal QRS duration and normal axis, originating from a region remote from the His bundle

Hiroko Asakai, MD, Laura Fenwick, BSc, Robert M. Hamilton, MD, FRCP(C)

Successful catheter ablation of idiopathic ventricular tachycardia originating from the top of the left ventricular posterior papillary muscle near the.

An unusual cause of HV prolongation

Incremental value of electroanatomical mapping for the diagnosis of arrhythmogenic right ventricular cardiomyopathy in a patient with sustained ventricular.

Abnormal epicardial electrophysiologic substrate in patients with early repolarization pattern and reduced left ventricular systolic function: A report.

Radiofrequency ablation of ventricular tachycardia originating from a lipomatous hamartoma localized in the right ventricle cavity Jin Xu, PhD, Yingmin.

Worsening of mitral valve regurgitation after radiofrequency catheter ablation of ventricular arrhythmia originating from a left ventricular papillary.

Colin Yeo, MBBS, Martin Green, MD, Robert Lemery, MD, FHRS

Radiofrequency catheter ablation for treatment of premature ventricular contractions triggering ventricular fibrillation from the right ventricular outflow.

Intermittent failure to capture: What is the mechanism?

Peter Kabunga, MBChB, MRCP, George J. Klein, MD, FHRS, Raymond W

Quinidine for Brugada syndrome: Panacea or poison?

Nishaki Mehta, MD, Benjamin E. Peterson, MD, Roy M. John, MD, PhD

Usefulness of a multi-spline duodecapolar catheter with smaller electrodes and closer spacings for mapping and ablation of Purkinje-related premature.

Majid Husain, MD, Anthony McCanta, MD, FHRS, Anjan S

Clinical problem solving: Maneuvering around a narrow complex tachycardia in a patient with Mustard repair for transposition of the great arteries Nicholas.

Late atrial tachycardia originating from donor pulmonary vein in a double lung transplant recipient Kumar Sanam, MD, Daniel Holmes, RCIS, CCT, Dipak.

Successful catheter ablation of focal ventricular tachycardia originating from right bundle branch without making right bundle branch block, using pharmacologic.

Saurabh Kumar, BSc(Med)/MBBS, PhD, William G. Stevenson, MD, Usha B

Two apparently remote types of ventricular tachycardia from a single right bundle branch focal source Jaromír Josiek, MD, Jaroslav Januška, MD, PhD,

Ablation of a symptomatic spontaneous automatic focus arising from an atriofascicular fiber Sandrine Venier, MD, Paul Khairy, MD, PhD, Bernard Thibault,

Resolution of new left bundle branch block and ventricular tachycardia with immunosuppressive therapy in a patient with cardiac sarcoidosis Aatish Garg,

Jeffrey Munro, DO, Win-Kuang Shen, MD, FHRS, Komandoor Srivathsan, MD

Chance M. Witt, MD, Samuel J. Asirvatham, MD, FHRS, Carole A

A wide QRS complex tachycardia utilizing an atypical accessory pathway in latent Wolff- Parkinson-White syndrome: Manifestation of anterograde conduction.

HeartRhythm Case Reports

Presentation transcript:

Irregular wide QRS complex tachycardia in a patient with pulmonary hypertension: What is the mechanism? Abigail Louise D. Te, MD, Fa-Po Chung, MD, Yenn-Jiang Lin, MD, PhD, Shih-Ann Chen, MD HeartRhythm Case Reports Volume 2, Issue 1, Pages 63-66 (January 2016) DOI: 10.1016/j.hrcr.2015.10.003 Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 1 The 12-lead electrocardiogram (ECG) at baseline and during tachycardia. A: The baseline ECG showed atrial fibrillation and narrow QRS complex. B: ECG during wide QRS complex tachycardia with left bundle branch block morphology, a superior axis, V5 transition, and QRS duration of 142 msec. HeartRhythm Case Reports 2016 2, 63-66DOI: (10.1016/j.hrcr.2015.10.003) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 2 Voltage and substrate mapping. A: Voltage mapping depicted no remarkable low voltage zone (defined by voltage <1.5 mV). B: The activation map of the ventricular tachycardia (VT) / ventricular premature complex (VPC) demonstrated the earliest activation site localized at the anterior mid free wall of the right ventricle, and a Purkinje potential (*) preceded the onset of wide QRS tachycardia by 30 msec. Pace mapping at the earliest activation site yielded 12/12 leads matched QRS morphology. C: Remapping after initial ablation showed another VT/VPC originating from the foci at a distance of 11.2 mm from the previous ablation site with a Purkinje potential (*) preceding VT/VPC by 32 msec. Pace mapping at the foci also yielded 12/12 leads matched QRS morphology comparing with the documented VT/VPC. Radiofrequency ablation successfully terminated the VT/VPC. HeartRhythm Case Reports 2016 2, 63-66DOI: (10.1016/j.hrcr.2015.10.003) Copyright © 2016 Heart Rhythm Society Terms and Conditions