Catheter ablation of the slow pathway as a treatment for severe sinus node dysfunction in a patient with incessant atrioventricular nodal reentry tachycardia

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Flecainide-induced incessant orthodromic atrioventricular reentrant tachycardia in Wolff- Parkinson-White syndrome: Uneven depression of accessory pathway.

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Catheter ablation of the slow pathway as a treatment for severe sinus node dysfunction in a patient with incessant atrioventricular nodal reentry tachycardia Gilad Margolis, MD, Yoav Michowitz, MD, Aharon Glick, MD, Bernard Belhassen, MD HeartRhythm Case Reports Volume 4, Issue 3, Pages 113-116 (March 2018) DOI: 10.1016/j.hrcr.2017.12.007 Copyright © 2017 Heart Rhythm Society Terms and Conditions

Figure 1 Longest posttachycardia sinus pause (5.9 seconds) recorded in the electrophysiology laboratory a few minutes before SP ablation. Note that the tachycardia preceding the sinus pause is an atrial tachycardia associated with long P′R intervals due to antegrade SP conduction. SP = slow pathway. HeartRhythm Case Reports 2018 4, 113-116DOI: (10.1016/j.hrcr.2017.12.007) Copyright © 2017 Heart Rhythm Society Terms and Conditions

Figure 2 Short-lasting episodes of atrial tachycardia recorded ∼1 minute after antegrade SP ablation. Note sinus pauses ranging from 0.9 to 1.4 seconds. Also note relatively short P′R intervals during tachycardia. SP = slow pathway. HeartRhythm Case Reports 2018 4, 113-116DOI: (10.1016/j.hrcr.2017.12.007) Copyright © 2017 Heart Rhythm Society Terms and Conditions

Figure 3 Tracing recorded ∼2 minutes after the previous one. A 30-second train of atrial pacing at a cycle length of 440 ms is followed by a sinus pause of 1.1 seconds. HeartRhythm Case Reports 2018 4, 113-116DOI: (10.1016/j.hrcr.2017.12.007) Copyright © 2017 Heart Rhythm Society Terms and Conditions