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A case of 'tachy-brady syndrome': What is the mechanism?

Namboodiri N, Bohora S, Ajitkumar VK, Tharakan JA - Indian Pacing Electrophysiol J (2016)

Bottom Line: A young male presented with incessant narrow QRS tachycardia and left ventricular dysfunction. 24-Holter monitoring revealed multiple episodes of sustained and nonsustained episodes of tachycardia with prolonged sinus pauses at termination.The analysis of the electrocardiogram, followed by an invasive electrophysiological study, suggested an unusual mechanism for this tachy-brady syndrome.

View Article: PubMed Central - PubMed

Affiliation: Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India.

ABSTRACT
A young male presented with incessant narrow QRS tachycardia and left ventricular dysfunction. 24-Holter monitoring revealed multiple episodes of sustained and nonsustained episodes of tachycardia with prolonged sinus pauses at termination. The analysis of the electrocardiogram, followed by an invasive electrophysiological study, suggested an unusual mechanism for this tachy-brady syndrome.

No MeSH data available.


Related in: MedlinePlus

Intracardiac electrogram during the tachycardia. The tracings from the top to bottom are leads V1, I and II, followed by intracardiac electrograms from high right atrium (HRA), distal His bundle (HBD), coronary sinus proximal to distal (CS), and the right ventricular apex (RVA). A paced beat from the RVA during His refractoriness terminates the tachycardia and the next sinus beat reinitiates the tachycardia. The QRS morphology of the paced beat suggests ventricular fusion.
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fig2: Intracardiac electrogram during the tachycardia. The tracings from the top to bottom are leads V1, I and II, followed by intracardiac electrograms from high right atrium (HRA), distal His bundle (HBD), coronary sinus proximal to distal (CS), and the right ventricular apex (RVA). A paced beat from the RVA during His refractoriness terminates the tachycardia and the next sinus beat reinitiates the tachycardia. The QRS morphology of the paced beat suggests ventricular fusion.

Mentions: During electrophysiological study, sinus cycle length was 734 ms with normal atrio-hisian (AH) and His-ventricular (HV) intervals. Atrial pacing till atrioventricular (AV) wenckebaching didn't reveal any preexcitation. No dual AV nodal physiology was seen. The clinical tachycardia was easily induced on ventricular pacing. The termination and re-initiation of the tachycardia are shown in Fig. 2.


A case of 'tachy-brady syndrome': What is the mechanism?

Namboodiri N, Bohora S, Ajitkumar VK, Tharakan JA - Indian Pacing Electrophysiol J (2016)

Intracardiac electrogram during the tachycardia. The tracings from the top to bottom are leads V1, I and II, followed by intracardiac electrograms from high right atrium (HRA), distal His bundle (HBD), coronary sinus proximal to distal (CS), and the right ventricular apex (RVA). A paced beat from the RVA during His refractoriness terminates the tachycardia and the next sinus beat reinitiates the tachycardia. The QRS morphology of the paced beat suggests ventricular fusion.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4834438&req=5

fig2: Intracardiac electrogram during the tachycardia. The tracings from the top to bottom are leads V1, I and II, followed by intracardiac electrograms from high right atrium (HRA), distal His bundle (HBD), coronary sinus proximal to distal (CS), and the right ventricular apex (RVA). A paced beat from the RVA during His refractoriness terminates the tachycardia and the next sinus beat reinitiates the tachycardia. The QRS morphology of the paced beat suggests ventricular fusion.
Mentions: During electrophysiological study, sinus cycle length was 734 ms with normal atrio-hisian (AH) and His-ventricular (HV) intervals. Atrial pacing till atrioventricular (AV) wenckebaching didn't reveal any preexcitation. No dual AV nodal physiology was seen. The clinical tachycardia was easily induced on ventricular pacing. The termination and re-initiation of the tachycardia are shown in Fig. 2.

Bottom Line: A young male presented with incessant narrow QRS tachycardia and left ventricular dysfunction. 24-Holter monitoring revealed multiple episodes of sustained and nonsustained episodes of tachycardia with prolonged sinus pauses at termination.The analysis of the electrocardiogram, followed by an invasive electrophysiological study, suggested an unusual mechanism for this tachy-brady syndrome.

View Article: PubMed Central - PubMed

Affiliation: Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India.

ABSTRACT
A young male presented with incessant narrow QRS tachycardia and left ventricular dysfunction. 24-Holter monitoring revealed multiple episodes of sustained and nonsustained episodes of tachycardia with prolonged sinus pauses at termination. The analysis of the electrocardiogram, followed by an invasive electrophysiological study, suggested an unusual mechanism for this tachy-brady syndrome.

No MeSH data available.


Related in: MedlinePlus