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Limitations of 12-lead electrocardiogram wide complex tachycardia algorithms in a patient with left atrial flutter and large myocardial infarction  Carlos.

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Presentation on theme: "Limitations of 12-lead electrocardiogram wide complex tachycardia algorithms in a patient with left atrial flutter and large myocardial infarction  Carlos."— Presentation transcript:

1 Limitations of 12-lead electrocardiogram wide complex tachycardia algorithms in a patient with left atrial flutter and large myocardial infarction  Carlos Macias, MD, Houman Khakpour, MD, Eric Buch, MD, Kalyanam Shivkumar, MD, PhD, Jason S. Bradfield, MD  HeartRhythm Case Reports  Volume 5, Issue 2, Pages (February 2019) DOI: /j.hrcr Copyright © 2018 Heart Rhythm Society Terms and Conditions

2 Figure 1 A: The 12-lead electrocardiogram (ECG) during wide complex tachycardia (WCT) showing atypical right bundle branch block and R wave in lead aVR. B: The 12-lead ECG during WCT with occasional narrow QRS complexes, possibly consistent with capture beats C: The 12-lead ECG during sinus rhythm after termination of WCT. HeartRhythm Case Reports 2019 5, 70-73DOI: ( /j.hrcr ) Copyright © 2018 Heart Rhythm Society Terms and Conditions

3 Figure 2 A: Surface leads and intracardiac tracing during wide complex tachycardia showing atrial flutter (AFL) with cycle length of 220 ms and ventricular cycle length of 440 ms. B: Following 24 mg of intravenous adenosine, AFL persists despite atrioventricular node (AVN) block. Note surface electrocardiogram during AVN block shows 2 beats of narrow complex QRS (second and third QRS complex) with precordial Q waves similar to narrow complexes in Figure 1B. C: Entrainment of AFL from the left atrial roof shows concealed fusion with a postpacing interval (PPI)–tachycardia cycle length (TCL) of 4 ms. D: Entrainment of AFL from CS3,4 (distal CS) shows PPI–TCL of 39 ms. ABL = ablation; CS = coronary sinus; HIS = His catheter proximal (p), mid (m), and distal (d). HeartRhythm Case Reports 2019 5, 70-73DOI: ( /j.hrcr ) Copyright © 2018 Heart Rhythm Society Terms and Conditions

4 Figure 3 A: Right anterior oblique fluoroscopic view demonstrating the position of the AtriClip left atrial appendage (LAA) exclusion system (AtriCure, Mason, OH) with red arrows. Circular mapping catheter is in the left superior pulmonary vein (LSPV). Ablation catheter tip is at the location where atrial flutter (AFL) terminated during ablation (asterisk). B: Activation map of AFL showing propagation up the posterior left atrial wall and down the anterior wall. Brown dots show sites of ablation and green dot is the site of AFL termination. C: ABL d shows fractionated continuous signal on ABL distal positioned at the anterosuperior LAA/LSPV ridge (adjacent to AtriClip) at the site of AFL termination. D: Termination of atrial flutter with resumption of sinus rhythm. ABL = ablation; CS = coronary sinus. HeartRhythm Case Reports 2019 5, 70-73DOI: ( /j.hrcr ) Copyright © 2018 Heart Rhythm Society Terms and Conditions

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