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Jeffrey Munro, DO, Win-Kuang Shen, MD, FHRS, Komandoor Srivathsan, MD 

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Presentation on theme: "Jeffrey Munro, DO, Win-Kuang Shen, MD, FHRS, Komandoor Srivathsan, MD "— Presentation transcript:

1 Pre-excited tachycardia: Atrial tachycardia with a bystander left lateral accessory pathway 
Jeffrey Munro, DO, Win-Kuang Shen, MD, FHRS, Komandoor Srivathsan, MD  HeartRhythm Case Reports  Volume 2, Issue 4, Pages (July 2016) DOI: /j.hrcr Copyright © 2016 Heart Rhythm Society Terms and Conditions

2 Figure 1 Surface electrocardiograms of the wide complex tachycardia (top) and in normal sinus rhythm (bottom). HeartRhythm Case Reports 2016 2, DOI: ( /j.hrcr ) Copyright © 2016 Heart Rhythm Society Terms and Conditions

3 Figure 2 Induction of a wide complex tachycardia with atrial burst pacing (S1) (top). Changes in the VV interval follow changes in the AA interval. The last 3 pacing stimuli (*) did not capture the atrium since the local electrogram precedes the pacing artifact. Introduction of an atrial extrastimulus (S2) blocks in the left lateral accessory pathway and atrioventricular node without interrupting the tachycardia and is diagnostic of atrial tachycardia with bystander accessory pathway (bottom) (see text for details). Of note, the RVa catheter is in a septal location rather than apical because of the right bundle potential observed. (*) atrial electrogram and (^) His electrogram on His catheter. HeartRhythm Case Reports 2016 2, DOI: ( /j.hrcr ) Copyright © 2016 Heart Rhythm Society Terms and Conditions

4 Figure 3 Site of successful ablation of the left lateral accessory pathway (top). The arrows denote the accessory pathway potential. The atrial tachycardia was successfully ablated using a retrograde aortic approach, mapping the earliest local atrial electrogram (35 ms earlier than the surface P wave) in the non-coronary cusp of the aortic root (bottom). Termination occurred 5 seconds after the start of the ablation lesion. The last beat of atrial tachycardia is denoted by the asterisks. HeartRhythm Case Reports 2016 2, DOI: ( /j.hrcr ) Copyright © 2016 Heart Rhythm Society Terms and Conditions

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