Download - 21 yr old lady Recurrent tachycardia episodes Normal echo Inputs from Tahmeed and Chandrashekhar
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21 yr old ladyRecurrent tachycardia episodes
Normal echo
Inputs from Tahmeed and Chandrashekhar
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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
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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
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Intracardiacs-D/D now? Among available channels, A at His region is earlier. Same D/D as before
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Another episode, 3 minutes later- any further insight? No. Spontaneous termination after V.
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Analyse: VA time slightly longer with complete RBBB compared to incomplete RBBB.
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Comment- Spontaneous termination, fortuitous simultaneous RV pacing spike
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Route of retrograde conduction? No obvious decrement: AP likely
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What next? PVC during tachycardia; either his-synchronous or entrainment from RV
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Interpret: atrium entrained. Post-entrainment:-VAHV response.Corrected PPI-TCL in keeping with ORT
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Consistent with the prior diagnosis? Yes. His-refractory VPD advances the next A and resets tachycardia.
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Any further confirmation needed? No. Termination of tachycardia without A=ORTIf not, what next? Map the tricuspid annulus.
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Signal at RF site- where is this likely to be?Likely right sided (given prior findings); away from CS os and His area.
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After ablation
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RF site-LAO 40
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Final diagnosis:
Concealed right anterolateral AP with ORT
Successful RF ablation