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

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HeartRhythm Case Reports

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Successful demonstration of the detailed connection between the twin atrioventricular nodes and sling in a patient with asplenia syndrome Hitoshi Mori, MD, Naokata Sumitomo, MD, PhD, Syota Muraji, MD, Tomohiko Imamura, MD, Toshiki Kobayashi, MD, PhD, Ritsushi Kato, MD, PhD HeartRhythm Case Reports Volume 4, Issue 10, Pages 480-483 (October 2018) DOI: 10.1016/j.hrcr.2018.07.007 Copyright © 2018 Heart Rhythm Society Terms and Conditions

Figure 1 QRS morphology changed from a right bundle branch block pattern to a left bundle branch block pattern, without any change in tachycardia cycle length. The atrioventricular conduction time shortened with the change in QRS morphology from a right bundle branch block pattern (*) to a left bundle branch block pattern (†). However, the atrioventricular conduction time did not shorten with the change from the complete left bundle branch block pattern to the incomplete left bundle branch block pattern (††). HeartRhythm Case Reports 2018 4, 480-483DOI: (10.1016/j.hrcr.2018.07.007) Copyright © 2018 Heart Rhythm Society Terms and Conditions

Figure 2 A, B: Earliest atrial activation site of the tachycardia was observed at the 4 o’clock position on the valve annulus. C, D: The Stim-QRS interval was recorded, and the interval was shortest at the 10 o’clock position on the valve annulus. E, F: Catheter ablation was performed at the posterior atrioventricular (AV) node. G: The twin AV nodes were directly connected, and AV conduction through the right bundle branch diverged from the sling nadir to the anterior AV node. H: During right bundle branch block, AV conduction was through the left bundle branch nadir to the posterior AV node via the connecting sling, and the conduction time prolonged. HeartRhythm Case Reports 2018 4, 480-483DOI: (10.1016/j.hrcr.2018.07.007) Copyright © 2018 Heart Rhythm Society Terms and Conditions