21 yr old lady Recurrent tachycardia episodes Normal echo Inputs from Tahmeed and Chandrashekhar.
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Transcript of 21 yr old lady Recurrent tachycardia episodes Normal echo Inputs from Tahmeed and Chandrashekhar.
21 yr old ladyRecurrent tachycardia episodes
Normal echo
Inputs from Tahmeed and Chandrashekhar
During catheter insertion-D/D? Tachy initiated by PAC with prolongation of PR; P wave narrow, in ST segment; VA linking despite “wobble” in first few complexes makes AT unlikely. DD: Atypical AVNRT versus ORT
Another episode- any further information? RBBB during tachy this time. TCL longer than the previous tachy. However, difficult to draw conclusions since these are 2 separate episodes.
1400 ms 1300 ms
Intracardiacs-D/D now? Among available channels, A at His region is earlier. Same D/D as before
Another episode, 3 minutes later- any further insight? No. Spontaneous termination after V.
Analyse: VA time slightly longer with complete RBBB compared to incomplete RBBB.
Comment- Spontaneous termination, fortuitous simultaneous RV pacing spike
Route of retrograde conduction? No obvious decrement: AP likely
What next? PVC during tachycardia; either his-synchronous or entrainment from RV
Interpret: atrium entrained. Post-entrainment:-VAHV response.Corrected PPI-TCL in keeping with ORT
Consistent with the prior diagnosis? Yes. His-refractory VPD advances the next A and resets tachycardia.
Any further confirmation needed? No. Termination of tachycardia without A=ORTIf not, what next? Map the tricuspid annulus.
Signal at RF site- where is this likely to be?Likely right sided (given prior findings); away from CS os and His area.
After ablation
RF site-LAO 40
Final diagnosis:
Concealed right anterolateral AP with ORT
Successful RF ablation