30 yr old lady Recurrent paroxysmal tachycardias Normal echo Inputs from Tahmeed Contractor and Chandrashekhar.

Slides:

Advertisements

Similar presentations

PR interval Good Samaritan CSG.

Advertisements

Pr inciples of E P (His bundle, Mapping techniques) Dr. Meenu.

Management of Supraventricular Tachycardias

ECG Rhythm Interpretation

Atrioventricular Nodal Reentrant Tachycardia

Supraventricular Tachycardia: Making the diagnosis

Presentation Information

Dysrhythmia examples for residents Elias B Hanna, LSU New Orleans, Cardiology.

Junctional Rhythms / A-V Nodal Rhythm. Aims and Objectives.  Investigate common types of Junctional and AV nodal tachycardias.  Understand underlying.

Electrocardiogram Primer (EKG-ECG)

Supraventricular Arrhythmias

Supraventricular Arrhythmias Claire B. Hunter, M.D.

35 yr old man Recurrent tachy episodes Normal echo Inputs from Tahmeed Contractor, UCLA and Chandrashekhar, Chennai.

Leonard Steinberg, MD Timothy Knilans, MD The Heart Center Children’s Hospital Medical Center Cincinnati, OH The diagnosis and management of supraventricular.

EKG Interpretation: Arrhythmias Humayun J. Chaudhry, D.O., FACP, FACOI Assistant Dean for Pre-Clinical Education and Chairman, Department of Medicine N.Y.

80 yr old lady Normal Numerous episodes of palpitations (near- incessant) over many years, drug-refractory Inputs from Chandrashekhar and Aditya Kapoor.

EKG Interpretation.

SupraVentricular Tachycardia (SVT)

EKG Interpretation: Arrhythmias Mustafa Salehmohamed, D.O. Assistant Clinical Instructor Department of Medicine N.Y. College of Osteopathic Medicine October.

24 yr old man Recurrent tachy episodes Normal echo Inputs from Tahmeed and Chandrashekhar.

Workshop #5 VT and ICD Unknowns Chair: David J. Wilber, MD Faculty: John P. DiMarco, MD, PhD Francis E. Marchlinski, MD.

Morning report ECG Elias B Hanna, MD LSU New Orleans, Cardiology.

Tachyarrhythmia Gaurav Panchal. Arrhythmogenesis Impulse formation –Automaticity – inappropriate Tachy / brady; accelerated Ventricular rate after MI.

ECGs AFMAMS Resident Orientation March Lecture Outline ECG Basics Importance of systematically reading ECGs Rate Rhythm Axis Hypertrophy Intervals.

21 yr old lady Recurrent tachycardia episodes Normal echo Inputs from Tahmeed and Chandrashekhar.

Thank you for this challenge Raed Abu Sham’a. Sinus Rhythm Frequent APCs Three different QRS morphology: 1.regular sinus 2.narrow pre-excited 3.wide pre-excited.

By Dr. Zahoor Atrial Fibrillation There are no P-waves, QRS complexes appear irregularly irregular. 4.

Alternating bundle branch block  Alternating bundle branch block is diagnosed when conducted periods of RBBB and LBBB were noted in a patient on the.

Normal EKG – P wave: Atrial depolarization – PR interval: < 0.20 sec – QRS complex: ventricular depolarization – QRS interval < 0.10 sec SA 0.10 – 0.12.

“Advanced” EKG Reading Stefan Da Silva With special guest…. Dr. S. Weeks.

ECG Rounds July 22, 2004 Adam Oster R4.

30 yr old man Normal echo 3 episodes of paroxysmal tachy All LBBB Inputs from Chandrashekhar, Chennai.

ECG intereptation Abdualrahman ALshehri Lecturer King Saud University

EP Sale’s Training Summary.

41 yr old lady Recurrent episodes of tachycardia Sometimes terminated by deep breathing Normal echo Inputs from Ulhas Pandurangi.

48 year old man Recurrent tachy episodes Normal echo Inputs from Chandrashekhar.

1 Nora Goldschlager, M.D. Cardiology – San Francisco General Hospital UCSF Disclosures: None ECG MIMICS OF MYOCARDIAL ISCHEMIA AND INFARCTION.

14 yr old boy Ebstein’s anomaly Marked displacement of septal tricuspid leaflet. RA/RV moderately dilated. Mild TR Recurrent paroxysmal palpitations Inputs.

Thank you for this difficult ECG

ARRHYTHMIA Objectives At the end of this session students should be able to:  Distinguish the normal from abnormal rhythms.  Understand the pathophysiologic.

52 yr old lady Recurrent narrow QRS tachy Normal echo.

19 yr old boy Palpitations on effort since several weeks Normal echo Comments from Chandrashekhar and Tahmeed.

Supraventricular Arrhythmias AAT.A FLUTTER.A FIB

Date of download: 5/27/2016 Copyright © The American College of Cardiology. All rights reserved. From: ACC/AHA/ESC guidelines for the management of patients.

UCI Internal Medicine Mini-Lecture

ARRHYTHMIAS Jamil Mayet. Arrhythmias - learning objectives –Mechanisms of action of antiarrhythmic drugs –Diagnosis To differentiate the different types.

H. Barakpour,MD.,Electrophysiologist November 2014,Javad-Alaeme Heart Hospital.

Date of download: 6/22/2016 Copyright © The American College of Cardiology. All rights reserved. From: Separating non-isthmus- from isthmus-dependent atrial.

Date of download: 6/25/2016 Copyright © The American College of Cardiology. All rights reserved. From: Mechanism, localization and cure of atrial arrhythmias.

Arrhythmias and EKGs.

Rhythm recognition Workshop

Normal echo Inputs from Chandrashekhar

50 yr old man Recurrent tachy episodes since a few years

Atrial depolarization, initiated by the SA node, causes the P wave. Q

Mechanisms of Posterior Fascicular Tachycardia

Christopher F. Liu et al. JACEP 2016;j.jacep

Atrial premature beat.

1st degree H block prolonged PR

Christopher F. Liu et al. JACEP 2016;j.jacep

Wolff-Parkinson-White syndrome due to a left atrial appendage–to–left ventricular connection: A case of a successful pathway elimination from inside of.

Philippe Maury et al. JACEP 2016;2:

HeartRhythm Case Reports

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

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

Cardiac arrest in an adolescent with Uhl’s anomaly: Two unusual cardiac arrhythmia mechanisms Jeffrey P. Moak, MD, Gail D. Pearson, MD, ScD, Bradley.

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

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

Parsing a perplexing paroxysmal pathway

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

Left atrial access via an unroofed coronary sinus to eliminate fast/slow atypical AVNRT: A case report Gustavo X. Morales, MD, Yousef H. Darrat, MD,

Presentation transcript:

30 yr old lady Recurrent paroxysmal tachycardias Normal echo Inputs from Tahmeed Contractor and Chandrashekhar

Basal ECG- normal

During catheter insertion into CS-analyse. Narrow QRS tachy, noisy baseline. No ST deviation, clear P not seen. RR irregular before termination.

Intracardiacs-D/D? Short VA with eccentric atrial activation; CS 3,4 before his A; DD-ORT versus Left sided AT

Diagnosis confirmed? Eccentric activation: but minimal decrement; likely LL pathway

Tachy induced again: Same as previous tachy-ORT versus AT

Compare this with the previous tachy ECG: The second tachy (on the left) shows significant ST depressions

Intracardiacs- comment. Different atrial activation pattern, A earliest in CS 78/56 D/D: AT/Atypical AVNRT/2 nd ORT. Some CL variations (the are equal).

Interpret- Fused PVC did not advance A-no evidence of pathway. Not able to entrain the A during V pacing indicating an AT

Faster speed….A never entrained to Paced CL; tachycardia continues-rules out AVRT

And now? What next? ORT degenerates into multifocal AT

RF energy- Left lateral AP conduction changes to AV nodal conduction

RF site- LAO 40

After ablation- LV pacing shows retrograde AV nodal conduction

Adenosine after ablation- VA block No tachy inducible after this

Final diagnosis: Concealed left lateral AP with ORT, successfully ablated “Secondary” and non-specific atrial arrhythmias