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Hanney Gonna, MRCP, Alex Grimster, BSc, David Roberts, BSc, Mark M

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1 Concealed conduction in atrial tachyarrhythmia illustrated in a heartbeat 
Hanney Gonna, MRCP, Alex Grimster, BSc, David Roberts, BSc, Mark M. Gallagher, MD, FRCPI  HeartRhythm Case Reports  Volume 4, Issue 5, Pages (May 2018) DOI: /j.hrcr Copyright © 2017 Heart Rhythm Society Terms and Conditions

2 Figure 1 Examples of pauses from 2 different Holter recordings from the same patient. The corresponding ladder diagram is presented below the clinical recording. In each case, the pause relates to a nonconducted supraventricular ectopic beat or sequences of beats. In each case, the interval between the last ectopic beat and the subsequent sinus beat is shown to be similar to prevailing sinus cycle length, exonerating the sinus node from involvement in generating the pauses. HeartRhythm Case Reports 2018 4, DOI: ( /j.hrcr ) Copyright © 2017 Heart Rhythm Society Terms and Conditions

3 Figure 2 On the second ablation, atrial tachyarrhythmias similar to those documented on Holter monitoring were mapped to the left common pulmonary vein. A single point of reconnection of the vein was detected. Ablation at 25 W (dark arrow) resulted in isolation of the vein within 5 seconds, permitting the atrium to return to sinus rhythm despite continued chaotic activity in the vein. HeartRhythm Case Reports 2018 4, DOI: ( /j.hrcr ) Copyright © 2017 Heart Rhythm Society Terms and Conditions

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