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Supraventricular tachycardia and sinus rhythm with contralateral bundle branch block patterns.

Han S, Miller JM, Das MK - Korean Circ J (2014)

Bottom Line: A contralateral bundle branch block (BBB) aberration during tachycardia with a preexisting BBB strongly suggests the presence of ventricular tachycardia.The patient had orthodromic atrioventricular tachycardia with a left BBB aberration in the presence of a preexisting right BBB due to an abnormal His-Purkinje system.We learned that the contralateral BBB aberration with supraventricular tachycardia could be seen when the His-Purkinje system was abnormal.

View Article: PubMed Central - PubMed

Affiliation: Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, IN, USA.

ABSTRACT
A contralateral bundle branch block (BBB) aberration during tachycardia with a preexisting BBB strongly suggests the presence of ventricular tachycardia. We report on a middle-aged, female patient presented with wide QRS tachycardia. The patient had orthodromic atrioventricular tachycardia with a left BBB aberration in the presence of a preexisting right BBB due to an abnormal His-Purkinje system. We learned that the contralateral BBB aberration with supraventricular tachycardia could be seen when the His-Purkinje system was abnormal.

No MeSH data available.


Related in: MedlinePlus

Right ventricular burst pacing with a cycle length of 420 msec after AP ablation. His potential was obtained from left ventricle. During RV pacing, there was progressive prolongation of VH interval (arrows) that ended up with VA conduction block (Wenckebach VA block at below the His). p: proximal, d: distal, HRA: high right atrium, CS: coronary sinus, AP: accessory pathway, RV: right ventricle, VH: ventriculo-Hisian, VA: ventriculo-atrial.
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Figure 3: Right ventricular burst pacing with a cycle length of 420 msec after AP ablation. His potential was obtained from left ventricle. During RV pacing, there was progressive prolongation of VH interval (arrows) that ended up with VA conduction block (Wenckebach VA block at below the His). p: proximal, d: distal, HRA: high right atrium, CS: coronary sinus, AP: accessory pathway, RV: right ventricle, VH: ventriculo-Hisian, VA: ventriculo-atrial.

Mentions: The LBBB-T terminated without any following atrial activation; therefore, VT with 1:1 retrograde conduction was ruled out. The His-bundle activation during the tachycardia preceded the beginning of the QRS complex, which ruled out an ART. The site of the earliest atrial activation during the LBBB-T was in the mid-CS rather than in the His-bundle. Delivery of premature ventricular stimulus during the His-bundle refractory terminated tachycardia without atrial activation. This confirmed that the tachycardia was an ORT using a concealed left posterior AP. Ablation was successful and the tachycardia could no longer be induced. After ablation, VA conduction was present through the AV node only, but a VA conduction block occurred at the VH level with a Wenckebach pattern (Fig. 3), which suggested a conduction abnormality in the His-Purkinje system or between the His-Purkinje system and the ventricle.


Supraventricular tachycardia and sinus rhythm with contralateral bundle branch block patterns.

Han S, Miller JM, Das MK - Korean Circ J (2014)

Right ventricular burst pacing with a cycle length of 420 msec after AP ablation. His potential was obtained from left ventricle. During RV pacing, there was progressive prolongation of VH interval (arrows) that ended up with VA conduction block (Wenckebach VA block at below the His). p: proximal, d: distal, HRA: high right atrium, CS: coronary sinus, AP: accessory pathway, RV: right ventricle, VH: ventriculo-Hisian, VA: ventriculo-atrial.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4117850&req=5

Figure 3: Right ventricular burst pacing with a cycle length of 420 msec after AP ablation. His potential was obtained from left ventricle. During RV pacing, there was progressive prolongation of VH interval (arrows) that ended up with VA conduction block (Wenckebach VA block at below the His). p: proximal, d: distal, HRA: high right atrium, CS: coronary sinus, AP: accessory pathway, RV: right ventricle, VH: ventriculo-Hisian, VA: ventriculo-atrial.
Mentions: The LBBB-T terminated without any following atrial activation; therefore, VT with 1:1 retrograde conduction was ruled out. The His-bundle activation during the tachycardia preceded the beginning of the QRS complex, which ruled out an ART. The site of the earliest atrial activation during the LBBB-T was in the mid-CS rather than in the His-bundle. Delivery of premature ventricular stimulus during the His-bundle refractory terminated tachycardia without atrial activation. This confirmed that the tachycardia was an ORT using a concealed left posterior AP. Ablation was successful and the tachycardia could no longer be induced. After ablation, VA conduction was present through the AV node only, but a VA conduction block occurred at the VH level with a Wenckebach pattern (Fig. 3), which suggested a conduction abnormality in the His-Purkinje system or between the His-Purkinje system and the ventricle.

Bottom Line: A contralateral bundle branch block (BBB) aberration during tachycardia with a preexisting BBB strongly suggests the presence of ventricular tachycardia.The patient had orthodromic atrioventricular tachycardia with a left BBB aberration in the presence of a preexisting right BBB due to an abnormal His-Purkinje system.We learned that the contralateral BBB aberration with supraventricular tachycardia could be seen when the His-Purkinje system was abnormal.

View Article: PubMed Central - PubMed

Affiliation: Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, IN, USA.

ABSTRACT
A contralateral bundle branch block (BBB) aberration during tachycardia with a preexisting BBB strongly suggests the presence of ventricular tachycardia. We report on a middle-aged, female patient presented with wide QRS tachycardia. The patient had orthodromic atrioventricular tachycardia with a left BBB aberration in the presence of a preexisting right BBB due to an abnormal His-Purkinje system. We learned that the contralateral BBB aberration with supraventricular tachycardia could be seen when the His-Purkinje system was abnormal.

No MeSH data available.


Related in: MedlinePlus