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A narrow QRS complex Tachycardia with an apparently concentric retrograde atrial activation sequence.

Arias MA, Castellanos E, Puchol A, Pachon M - Indian Pacing Electrophysiol J (2009)

Bottom Line: The retrograde atrial activation sequence constitutes an initial important clue to elucidate the tachycardia mechanism during diagnostic electrophysiological testing in patients with supraventricular tachycardia.However, in some cases its correct analysis is challenging.

View Article: PubMed Central - PubMed

Affiliation: Cardiac Arrhythmia and Electrophysiology Unit. Department of Cardiology. Hospital Virgen de la Salud. Toledo. Spain. maapalomares@secardiologia.es

ABSTRACT
The retrograde atrial activation sequence constitutes an initial important clue to elucidate the tachycardia mechanism during diagnostic electrophysiological testing in patients with supraventricular tachycardia. However, in some cases its correct analysis is challenging.

No MeSH data available.


Related in: MedlinePlus

A: Surface electrocardiogram and intracardiac electrograms during tachycardia including recordings from a 5 Fr decapolar catheter placed in the CS with distal bipole at the anterolateral site of the AV groove. The earliest atrial activation is recorded at the CS poles 3-4 with these poles being positioned at the lateral region of the AV groove (3:30 h in left anterior oblique projection). B: Ablation catheter positioned at the lateral mitral annulus where the accessory pathway was successfully ablated being in close relationship with CS poles 3-4. The shortest VA during tachycardia is seen at this site.
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Figure 2: A: Surface electrocardiogram and intracardiac electrograms during tachycardia including recordings from a 5 Fr decapolar catheter placed in the CS with distal bipole at the anterolateral site of the AV groove. The earliest atrial activation is recorded at the CS poles 3-4 with these poles being positioned at the lateral region of the AV groove (3:30 h in left anterior oblique projection). B: Ablation catheter positioned at the lateral mitral annulus where the accessory pathway was successfully ablated being in close relationship with CS poles 3-4. The shortest VA during tachycardia is seen at this site.

Mentions: Mapping of the tricuspid annulus revealed a long VA interval, with the earliest atrial activation in the right anteroseptal region. This finding along with the inability to preexcite the atrium by ventricular extrastimuli delivered when the His bundle was refractory suggested us the remote possibility of the existence of a left-sided non-septal accessory pathway associated to intra-atrial conduction block (or delay) along the mitral isthmus. To explore such an option a 5 Fr decapolar catheter (2-8-2-mm interelectrode spacing) was placed in the coronary sinus with the distal electrode in the region of the anterolateral mitral annulus. Tachycardia was again induced by ventricular pacing and an eccentric retrograde atrial activation sequence with the earliest atrial activity recorded at the lateral aspect of the mitral annulus was demonstrated (Figure 2A). Therefore, the activation pattern appeared to be concentric only because of incomplete recordings along the coronary sinus.


A narrow QRS complex Tachycardia with an apparently concentric retrograde atrial activation sequence.

Arias MA, Castellanos E, Puchol A, Pachon M - Indian Pacing Electrophysiol J (2009)

A: Surface electrocardiogram and intracardiac electrograms during tachycardia including recordings from a 5 Fr decapolar catheter placed in the CS with distal bipole at the anterolateral site of the AV groove. The earliest atrial activation is recorded at the CS poles 3-4 with these poles being positioned at the lateral region of the AV groove (3:30 h in left anterior oblique projection). B: Ablation catheter positioned at the lateral mitral annulus where the accessory pathway was successfully ablated being in close relationship with CS poles 3-4. The shortest VA during tachycardia is seen at this site.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2655075&req=5

Figure 2: A: Surface electrocardiogram and intracardiac electrograms during tachycardia including recordings from a 5 Fr decapolar catheter placed in the CS with distal bipole at the anterolateral site of the AV groove. The earliest atrial activation is recorded at the CS poles 3-4 with these poles being positioned at the lateral region of the AV groove (3:30 h in left anterior oblique projection). B: Ablation catheter positioned at the lateral mitral annulus where the accessory pathway was successfully ablated being in close relationship with CS poles 3-4. The shortest VA during tachycardia is seen at this site.
Mentions: Mapping of the tricuspid annulus revealed a long VA interval, with the earliest atrial activation in the right anteroseptal region. This finding along with the inability to preexcite the atrium by ventricular extrastimuli delivered when the His bundle was refractory suggested us the remote possibility of the existence of a left-sided non-septal accessory pathway associated to intra-atrial conduction block (or delay) along the mitral isthmus. To explore such an option a 5 Fr decapolar catheter (2-8-2-mm interelectrode spacing) was placed in the coronary sinus with the distal electrode in the region of the anterolateral mitral annulus. Tachycardia was again induced by ventricular pacing and an eccentric retrograde atrial activation sequence with the earliest atrial activity recorded at the lateral aspect of the mitral annulus was demonstrated (Figure 2A). Therefore, the activation pattern appeared to be concentric only because of incomplete recordings along the coronary sinus.

Bottom Line: The retrograde atrial activation sequence constitutes an initial important clue to elucidate the tachycardia mechanism during diagnostic electrophysiological testing in patients with supraventricular tachycardia.However, in some cases its correct analysis is challenging.

View Article: PubMed Central - PubMed

Affiliation: Cardiac Arrhythmia and Electrophysiology Unit. Department of Cardiology. Hospital Virgen de la Salud. Toledo. Spain. maapalomares@secardiologia.es

ABSTRACT
The retrograde atrial activation sequence constitutes an initial important clue to elucidate the tachycardia mechanism during diagnostic electrophysiological testing in patients with supraventricular tachycardia. However, in some cases its correct analysis is challenging.

No MeSH data available.


Related in: MedlinePlus