Maged F. Nageh, MD,FHRS, Kamal Kotak, MD HeartRhythm Case Reports

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Presentation transcript:

Paradoxical preexcitation following successful ablation of a concealed accessory pathway Maged F. Nageh, MD,FHRS, Kamal Kotak, MD HeartRhythm Case Reports Volume 2, Issue 2, Pages 149-152 (March 2016) DOI: 10.1016/j.hrcr.2015.12.004 Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 1 A: Twelve-lead electrocardiogram (EKG) of sinus rhythm with echo beats from the concealed posteroseptal pathway in trigeminy and quadrigeminy pattern. B: Twelve-lead EKG of long RP supraventricular tachycardia (SVT). C: Sinus rhythm showing HV interval = 53 ms and echo beats from the concealed posteroseptal pathway. D: His-timed ventricular extrastimulus terminated the SVT with ventriculoatrial conduction block. E: Ablation of concealed pathway at the ostium of the middle cardiac vein with termination of incessant SVT. HeartRhythm Case Reports 2016 2, 149-152DOI: (10.1016/j.hrcr.2015.12.004) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 2 A: Twelve-lead electrocardiogram of manifest accessory pathway (AP) with coronary sinus (CS) pacing and in sinus rhythm. B: Earliest site mapped at left midseptum (pre-delta = 37 ms). C: Earliest site mapped at right midseptum (pre-delta = 33 ms). HeartRhythm Case Reports 2016 2, 149-152DOI: (10.1016/j.hrcr.2015.12.004) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 3 A: Left anterior oblique view of electroanatomic map with cranial tilt to visualize right and left sides of atrial septum. Red dots indicate ablation sites of the concealed accessory pathway (AP) at middle cardiac vein (MCV) ostium and of the manifest AP at right and left midseptum. Red arrow: His location; also shown is the position of the coronary sinus catheter. B: Summary of the proposed mechanisms for the phenomenon of paradoxical preexcitation. HeartRhythm Case Reports 2016 2, 149-152DOI: (10.1016/j.hrcr.2015.12.004) Copyright © 2016 Heart Rhythm Society Terms and Conditions