Resolution of the functional retrograde right bundle branch block during antidromic atrioventricular reciprocating tachycardia Keiko Takahashi, MD, PhD,

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Resolution of the functional retrograde right bundle branch block during antidromic atrioventricular reciprocating tachycardia Keiko Takahashi, MD, PhD, Koichi Nagashima, MD, PhD, Yasuo Okumura, MD, PhD, Ichiro Watanabe, MD, PhD, FHRS, Kazuki Iso, MD, Atsushi Hirayama, MD, PhD HeartRhythm Case Reports Volume 3, Issue 11, Pages 519-522 (November 2017) DOI: 10.1016/j.hrcr.2017.07.019 Copyright © 2017 Heart Rhythm Society Terms and Conditions

Figure 1 Twelve-lead electrocardiograms obtained during (A) clinical supraventricular tachycardia (SVT1) and (B) sinus rhythm. SVT1 was shown to be a wide QRS complex tachycardia (200 beats/min) with left bundle branch block morphology (panel A). Ventricular preexcitation was seen during sinus rhythm, suggestive of the presence of a right lateral accessory pathway (panel B). HeartRhythm Case Reports 2017 3, 519-522DOI: (10.1016/j.hrcr.2017.07.019) Copyright © 2017 Heart Rhythm Society Terms and Conditions

Figure 2 Intracardiac electrograms obtained during clinical supraventricular tachycardia (SVT1), antidromic atrioventricular reciprocating tachycardia that used a right lateral accessory pathway with shortening cycle lengths. The cycle length of the tachycardia decreased gradually along with the shortening of the ventricular-His interval and a slight prolongation of the His-atrial interval, suggesting resolution of the functional retrograde right bundle branch block. CS = coronary sinus; HBE = His bundle electrogram; HRA = high right atrium; RVA = right ventricular apex. HeartRhythm Case Reports 2017 3, 519-522DOI: (10.1016/j.hrcr.2017.07.019) Copyright © 2017 Heart Rhythm Society Terms and Conditions

Figure 3 Intracardiac electrograms of the 3 additional supraventricular tachycardias (SVTs). Atrioventricular reciprocating tachycardia (AVRT) that used a right lateral accessory pathway as the anterograde limb and left posterolateral accessory pathway (LPLAP) as the retrograde limb at a tachycardia cycle length (CL) of 326 ms (SVT2), orthodromic AVRT that used an LPLAP at a tachycardia CL of 258 ms (SVT3), and common atrioventricular nodal reentrant tachycardia at a CL of 440 ms (SVT4) were induced. AP = accessory pathway; AVNRT = atrioventricular nodal reentrant tachycardia; CS = coronary sinus; HBE = His bundle electrogram; HRA = high right atrium; LA = left atrium; LV = left ventricle; RA = right atrium; RV = right ventricle; RVA = right ventricular apex. HeartRhythm Case Reports 2017 3, 519-522DOI: (10.1016/j.hrcr.2017.07.019) Copyright © 2017 Heart Rhythm Society Terms and Conditions