80 yr old lady normal numerous episodes of palpitations (near- incessant) over many years,...
Post on 11-Jan-2016
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80 yr old ladyNormal
Numerous episodes of palpitations (near-incessant) over many years, drug-refractory
Inputs from Chandrashekhar and Aditya Kapoor
As the EP procedure began…D/D?Long RP tachycardia, narrow P : Atypical AVNRT, Coumel (PJRT), AT arising close to CS OS
What next?Bring in His-refractory VPD and look for atrial advancement with reset/delay/tachy termination- indicates Coumel. Next do incremental V pacing at a rate 30 msecs faster than the tachycardia and look for VA dissociation. If VA conduction, after stopping V pacing look for the evidence of VAAV or VAV response VAAV response indicates an AT, VAV response indicates it may be either Atypical AVNRT or Coumel. Long VA: CS 7/8 and Hisp a bit early than
Tachy induction-commentInduction of a long RP tachycardia during CS pacing without any prolongation of the PR interval
Intracardiacs… A during tachy equally early at HIS and CS os (CS78-910).However, not much earlier than P wave onset
Analyse- VA conduction appears concentric, long VAERP
Adenosine-analyse. Prolongation of the AA interval prior to termination.
Terminates with a V: not very helpful…
Intracardiacs during adenosine- any further insight?Not really. A-V remains constant, the A-A and V-A prolong prior to termination.
Tachy mechanism?Not yet confirmed
Overdrive RV pacing during tachy, showing VA dissociation without affectingtachycardia cycle length.
Now AT confirmed!
Good signal to ablate? Yes: A early…unipolar goodLikely site?
RF site-LAO 40
RF site- RAO 30
RF energy- clean early termination.No tachy inducible after this
Energy starts here
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