1. Normal echo Inputs from Chandrashekhar
4 year old girl Recurrent SVT 200/min Breakthroughs on propafenone
Normal echo
Inputs from Chandrashekhar

2. Tachy induced during catheter insertion- D/D?: ORT/AVNRT/AT

3. Tachy induced by APDs- analyse. CS56 A earliest, A not seen in His
Tachy induced by APDs- analyse. CS56  A earliest, A not seen in His.  With RBBB there is some increase in the TCL ( ) are equal. Strongly suggests a right AT with ORT.

4. Route of VA conduction? AV node/septal AP

5. Another induction-analyse. SVT with LBBB

6. Intracardiacs- D/D at this stage
Intracardiacs- D/D at this stage? ORT with LBBB most likely in view of earlier data

7. Any further insight? No change in TCL with LBBB

8. Intracardiacs. No change in TCL with LBBB

9. Diagnosis clinched. Yes, spontaneus termination after A
Diagnosis clinched? Yes, spontaneus termination after A. Or any further manouever needed?

10. Interpret- His refractory VPD during NCT  No effect is seen

11. RFD at the CS os - A is late at CS OS

12. At IAS adjacent to the apex of the triangle of Koch
At this location RF D shows continuous electrical activity with RFD A earlier

13. This was the earliest ‘A’ (see next slide).
Analyse the RF signal. RF D  A is earliest. A small His is seen in rfD.
This was the earliest ‘A’ (see next slide).

14. LAO 40. This was the site. What next? We can map the aortic sinuses

15. What about this site? RF D showing better signals even earlier A

16. RF site- RAO 30

17. RF site- LAO 40

18. RF energy…. Tachy termination in AP

19. Aortic root angio after ablation- LAO 40. No AR

20. Final trace- No VA conduction