WPW syndrome and AVRT

Size: px
Start display at page:

Download "WPW syndrome and AVRT"

Transcription

1 WPW syndrome and AVRT Myung-Yong Lee, MD, PhD Division of Cardiology Department of Internal Medicine School of Medicine Dankook University, Cheonan, Korea

2 Supraventricular tachycardia (SVT) Paroxysmal supraventricular tachycardia (PSVT) Atrial fibrillation (AF) Sinus tachycardia Physiologic sinus tachycardia Inappropriate sinus tachycardia Atrial tachycardia (AT) Focal AT Sinus node reentry tachycardia Multifocal atrial tachycardia (MAT) Atrial flutter Cavotricuspid isthmus dependent atrial flutter: typical Cavotricuspid isthmus dependent atrial flutter: reverse typical Atypical or non cavotricuspid isthmus dependent atrial flutter Junctional tachycardia Atrioventricular nodal reentrant tachycardia (AVNRT) Typical AVNRT Atypical AVNRT Accessory pathway Manifest accessory pathways Concealed accessory pathway Pre-excitation pattern Asymptomatic pre-excitation (isolated pre-excitation) Wolff-Parkinson-White syndrome Atrioventricular reentrant tachycardia (AVRT) Orthodromic AVRT Antidromic AVRT Permanent form of junctional reciprocating tachycardia An umbrella term used to describe tachycardias (atrial and/or ventricular rates in excess of 100 bpm at rest), the mechanism of which involves tissue from the His bundle or above. A clinical syndrome characterized by the presence of a regular and rapid tachycardia of abrupt onset and termination. PSVT represents a subset of SVT. Richard L. Page et al. Circulation. 2016;133:e506-e574

3 Supraventricular tachycardia (SVT) Paroxysmal supraventricular tachycardia (PSVT) An umbrella term used to describe tachycardias (atrial and/or ventricular rates in excess of 100 bpm at rest), the mechanism of which involves tissue from the His bundle or above. A clinical syndrome characterized by the presence of a regular and rapid tachycardia of abrupt onset and termination. PSVT represents a subset of SVT. Atrial fibrillation (AF) Sinus tachycardia Physiologic sinus tachycardia Inappropriate sinus tachycardia Atrial tachycardia (AT) Focal AT Sinus node reentry tachycardia Multifocal atrial tachycardia (MAT) Atrial flutter Cavotricuspid isthmus dependent atrial flutter: typical Cavotricuspid isthmus dependent atrial flutter: reverse typical Atypical or non cavotricuspid isthmus dependent atrial flutter Junctional tachycardia Atrioventricular nodal reentrant tachycardia (AVNRT) Typical AVNRT Atypical AVNRT Accessory pathway Manifest accessory pathways Concealed accessory pathway Pre-excitation pattern Asymptomatic pre-excitation (isolated pre-excitation) Wolff-Parkinson-White syndrome Atrioventricular reentrant tachycardia (AVRT) Orthodromic AVRT Antidromic AVRT Permanent form of junctional reciprocating tachycardia (PJRT) Richard L. Page et al. Circulation. 2016;133:e506-e574

4 Accessory Pathways Atrium and ventricle: insulated by cardiac skeleton Normally, AV node is the only electrical connection between A and V Gray's Anatomy. Published January 1, 2008 Copyright from The Royal College of Surgeons of England

5 Accessory Pathways and Reentry WPW syndrome Sinus rhythm Orthodromic Antidromic SAN SAN SAN AVN AVN AVN Concealed AP PJRT Mahaim SAN SAN SAN AVN AVN AVN

6 Accessory Pathways and Reentry WPW syndrome Sinus rhythm SAN AVN

7 Accessory Pathways and Reentry WPW syndrome Antidromic SAN AVN

8 Accessory Pathways and Reentry WPW syndrome Orthodromic SAN AVN

9 Differential Diagnosis of Narrow QRS tachycardia QRS duration Regularity P waves RP interval Richard L. Page et al. Circulation. 2016;133:e506-e574

10 Typical AVNRT Pseudo r in V1 Pseudo S in the inferior leads 2015 KHRS_ARC_3_DKUH_#1 10

11 AVRT with Retrograde P RP interval 100 msec

12 ECG algorithm for AP localization J Cardiovasc Electrophysiol 1998;9:2

13 Accessory Pathway: Left Free Wall

14 Accessory Pathway: Septal

15 Accessory Pathway: Right Free Wall

16 Differentiation of PSVT in EPS Baseline Observations and Tachycardia Features Prevalence (%) Positive Predictive Value (%) AVNRT ORT AT Pre-excitation present during sinus rhythm Extranodal response to para-hisian pacing VA block cycle length > 600 msec at baseline Septal VA interval > 70 msec Eccentric atrial activation Spontaneous AV block during tachycardia Spontaneous termination with AV block Development of LBBB Increase in VA interval > 20 msec with BBB

17 Eccentric Atrial Activation Distal CS Distal CS His His HRA Proximal CS RV HRA RV Proximal CS 2015 KHRS_ARC_3_DKUH_#3 17

18 Induction with AH Jump and Concentric Atrial Activation

19 His Synchronious Ventricular Extrastimulation (V reset) 406 msec 382 msec

20 His Synchronious Ventricular Extrastimulation (V reset) 20 msec

21 PPI-TCL: AVRT 510 msec 442 msec PPI-TCL = 68 (<115)

22 PPI-TCL: AVNRT 521 msec 337 msec PPI-TCL = 184 ( 115)

23 Coumel s law Positive Prediction Value: 100% in ORT Ipsilateral BBB produces prolonged TCL Narrrow QRS Ipsilateral BBB Contralateral BBB SAN SAN SAN AVN AVN AVN

24 Coumel s law 294 msec 251 msec 243 msec

25 294 msec 251 msec 243 msec SAN SAN SAN AVN AVN AVN +43 ms Ipsilateral BBB Narrrow QRS Contralateral BBB TCL: 294 ms TCL: 251 ms

26 Acute treatment of orthodromic AVRT Richard L. Page et al. Circulation. 2016;133:e506-e574

27 Acute treatment of orthodromic AVRT Richard L. Page et al. Circulation. 2016;133:e506-e574

28 Ongoing management of orthodromic AVRT Richard L. Page et al. Circulation. 2016;133:e506-e574

29 Success and Complication Rate for Ablation of AVRT Acute success rate: 93% Recurrent Rate: 8% Major Complications Overall 2.8% PPM 0.3% Death 0.1% Tamponade 0.4% Spector P, et al. Am J Cardiol. 2009;104: Calkins H, et al. Circulation. 1999;99:

30 RFCA

31 Hooray!!

32 Thank you for your attention

Supraventricular Tachycardia (SVT)

Supraventricular Tachycardia (SVT) Supraventricular Tachycardia (SVT) Daniel Frisch, MD Cardiology Division, Electrophysiology Section Thomas Jefferson University Hospital daniel.frisch@jefferson.edu Short RP Are these the Mid same RP tachycardias?

More information

Supraventricular Tachycardia (SVT)

Supraventricular Tachycardia (SVT) Supraventricular Tachycardia (SVT) Bruce Stambler, MD Piedmont Heart Atlanta, GA Supraventricular Tachycardia Objectives Types and mechanisms AV nodal reentrant tachycardia (AVNRT) AV reciprocating tachycardia

More information

In certain cases of supraventricular

In certain cases of supraventricular Case Report Hellenic J Cardiol 2013; 54: 469-473 A Tachycardia with Varying QRS Morphology and RP Intervals: Differential Diagnosis and Therapy Socrates Korovesis, Eleftherios Giazitzoglou, Demosthenes

More information

Differential diagnosis and pacing in maneuvers narrow QRS tachycardia. Richard Schilling

Differential diagnosis and pacing in maneuvers narrow QRS tachycardia. Richard Schilling Differential diagnosis and pacing in maneuvers narrow QRS tachycardia Richard Schilling Differential diagnosis of narrow complex QRS tachycardia Anything that activates the ventricle normally via the His

More information

Case-Based Practical ECG Interpretation for the Generalist

Case-Based Practical ECG Interpretation for the Generalist Case-Based Practical ECG Interpretation for the Generalist Paul D. Varosy, MD, FACC, FAHA, FHRS Director of Cardiac Electrophysiology VA Eastern Colorado Health Care System Associate Professor of Medicine

More information

Uncommon forms of AV reentry: atrio and fasciculo-ventricular fibers, slow conducting fibers. Jesus Almendral, Madrid, Spain

Uncommon forms of AV reentry: atrio and fasciculo-ventricular fibers, slow conducting fibers. Jesus Almendral, Madrid, Spain Uncommon forms of AV reentry: atrio and fasciculo-ventricular fibers, slow conducting fibers Jesus Almendral, Madrid, Spain Common forms of AV reentry Accessory pathways: Upper insertion: atrium Lower

More information

LONG RP TACHYCARDIA MAPPING AND RF ABLATION

LONG RP TACHYCARDIA MAPPING AND RF ABLATION LONG RP TACHYCARDIA MAPPING AND RF ABLATION Dr. Hayam Eldamanhoury Ain shams univeristy Arrhythmia is a too broad topic SVT is broadly defined as narrow complex ( unless aberrant conduction ) Requires

More information

(living in the fast lane)

(living in the fast lane) (living in the fast lane) Presented by M.D. Cardiology IT S A group of ECG and Electrophysiological abnormalities in which The atrial impulses are conducted partly or completely, PREMATURELY, to the ventricles

More information

The Efficient and Smart Methods for Diagnosis of SVT 대구파티마병원순환기내과정병천

The Efficient and Smart Methods for Diagnosis of SVT 대구파티마병원순환기내과정병천 The Efficient and Smart Methods for Diagnosis of SVT 대구파티마병원순환기내과정병천 Differentiation Supraventricular Origin from Ventricular Origin on ECG. QRS-Complex Width. 1. Narrow QRS-Complex Tachycardia (

More information

ACCESSORY PATHWAYS AND SVT. Neil Grubb Royal Infirmary of Edinburgh

ACCESSORY PATHWAYS AND SVT. Neil Grubb Royal Infirmary of Edinburgh ACCESSORY PATHWAYS AND SVT Neil Grubb Royal Infirmary of Edinburgh Bypass tracts - properties accessory AV connections usually endocardial may exhibit unidirectional conduction conduction properties similar

More information

Supraventricular Tachycardia: From Fetus to Adult. Mohamed Hamdan, MD

Supraventricular Tachycardia: From Fetus to Adult. Mohamed Hamdan, MD Supraventricular Tachycardia: From Fetus to Adult Mohamed Hamdan, MD Learning Objectives Define type of SVT by age Describe clinical approach Describe prenatal and postnatal management of SVT 2 SVT Across

More information

Asymptomatic patient with WPW

Asymptomatic patient with WPW Asymptomatic patient with WPW Dimosthenis Avramidis, MD. Arrythmiologist Mitera Children s Hospital Athens Greece Scientific Associate 1st Cardiology Dpt Evangelismos Hospital Athens Greece Preexcitation

More information

Tachy. Induction tachycardia lead ECG during Tachy /25/2009. Sinus Rhythm Single His

Tachy. Induction tachycardia lead ECG during Tachy /25/2009. Sinus Rhythm Single His 12-lead ECG during Tachy 10.30.31 Sinus Rhythm Single His 11.20.02 Induction tachycardia 11.23.23 Tachy 11.25.23 1 I This finding excludes: (a) AVNRT (either typical or atypical) Tachy: Alternating cycle

More information

Journal of the American College of Cardiology Vol. 36, No. 2, by the American College of Cardiology ISSN /00/$20.

Journal of the American College of Cardiology Vol. 36, No. 2, by the American College of Cardiology ISSN /00/$20. Journal of the American College of Cardiology Vol. 36, No. 2, 2000 2000 by the American College of Cardiology ISSN 0735-1097/00/$20.00 Published by Elsevier Science Inc. PII S0735-1097(00)00770-1 Diagnostic

More information

Chapter 16: Arrhythmias and Conduction Disturbances

Chapter 16: Arrhythmias and Conduction Disturbances Complete the following. Chapter 16: Arrhythmias and Conduction Disturbances 1. Cardiac arrhythmias result from abnormal impulse, abnormal impulse, or both mechanisms together. 2. is the ability of certain

More information

Differentiating Slow Fast Atrioventricular Nodal Reentry Tachycardia From Atrioventrcular..

Differentiating Slow Fast Atrioventricular Nodal Reentry Tachycardia From Atrioventrcular.. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 16, Issue 1 Ver. X (January. 2017), PP 69-77 www.iosrjournals.org Differentiating Slow Fast Atrioventricular

More information

TACHYARRHYTHMIAs. Pawel Balsam, MD, PhD

TACHYARRHYTHMIAs. Pawel Balsam, MD, PhD TACHYARRHYTHMIAs Pawel Balsam, MD, PhD SupraVentricular Tachycardia Atrial Extra Systole Sinus Tachycardia Focal A. Tachycardia AVRT AVNRT Atrial Flutter Atrial Fibrillation Ventricular Tachycardia Ventricular

More information

Basic Electrophysiology Protocols

Basic Electrophysiology Protocols Indian Journal of Cardiology ISSN-0972-1622 2012 by the Indian Society of Cardiology Vol. 15, (3-4), 27-37 [ 27 Review Article Shomu Bohora Assistant Professor, Deptt. of Cardiology, U.N. Mehta Institute

More information

Ablation Update and Case Studies. Lawrence Nair, MD, FACC Director of Electrophysiology Presbyterian Heart Group

Ablation Update and Case Studies. Lawrence Nair, MD, FACC Director of Electrophysiology Presbyterian Heart Group Ablation Update and Case Studies Lawrence Nair, MD, FACC Director of Electrophysiology Presbyterian Heart Group Disclosures No financial relationships to disclose Objectives At the conclusion of this activity,

More information

A Narrow QRS Complex Tachycardia With An Apparently Concentric Retrograde Atrial Activation Sequence

A Narrow QRS Complex Tachycardia With An Apparently Concentric Retrograde Atrial Activation Sequence www.ipej.org 125 Case Report A Narrow QRS Complex Tachycardia With An Apparently Concentric Retrograde Atrial Activation Sequence Miguel A. Arias MD, PhD; Eduardo Castellanos MD, PhD; Alberto Puchol MD;

More information

Ventricular Preexcitation (Wolff-Parkinson-White Syndrome and Its Variants) 柯文欽醫師 國泰綜合醫院心臟內科主治醫師 臺北醫學大學講師

Ventricular Preexcitation (Wolff-Parkinson-White Syndrome and Its Variants) 柯文欽醫師 國泰綜合醫院心臟內科主治醫師 臺北醫學大學講師 Ventricular Preexcitation (Wolff-Parkinson-White Syndrome and Its Variants) 柯文欽醫師 國泰綜合醫院心臟內科主治醫師 臺北醫學大學講師 The Nobel Prize in Physiology or Medicine 1924 "for his discovery of the mechanism of the electrocardiogram"

More information

ECG Interactive Session

ECG Interactive Session SA HEART 2018 PRE-CONGRESS WORKSHOP 4 OCTOBER 2018 ECG Interactive Session Ashley Chin Cardiologist/Electrophysiologist University of Cape Town Groote Schuur Hospital ECG 1 Which ONE of the following is

More information

Case Report Wide-QRS Tachycardia Inducible by Both Atrial and Ventricular Pacing

Case Report Wide-QRS Tachycardia Inducible by Both Atrial and Ventricular Pacing Hellenic J Cardiol 2008; 49: 446-450 Case Report Wide-QRS Tachycardia Inducible by Both Atrial and Ventricular Pacing ELEFTHERIOS GIAZITZOGLOU, DEMOSTHENES G. KATRITSIS Department of Cardiology, Athens

More information

Declaration of conflict of interest NONE

Declaration of conflict of interest NONE Declaration of conflict of interest NONE Transatlantic Electrophysiology Lessons for and from Iberoamerica European Society of Cardiology Mexican Society of Cardiology Wolff-Parkinson-White Syndrome in

More information

ECG QUIZ Luc DE ROY Brussels Belgium Disclosure in relation to this topic: none

ECG QUIZ Luc DE ROY Brussels Belgium Disclosure in relation to this topic: none ECG QUIZ Luc DE ROY Brussels Belgium Disclosure in relation to this topic: none TEST EXAMPLE What is the colour of this rectangle? 1. Blue? 2. Red? 3. Purple? 4. Green? 5. Yellow? 6. 1 and 3? 7. Any of

More information

ECG Interpretation Made Easy

ECG Interpretation Made Easy ECG Interpretation Made Easy Dr. A Tageldien Abdellah, MSc MD EBSC Lecturer of Cardiology- Hull University Hull York Medical School 2007-2008 ECG Interpretation Made Easy Synopsis Benefits Objectives Process

More information

Validation of right ventricular pacing response during SVT in mechanistic diagnosis. (Transition zone)

Validation of right ventricular pacing response during SVT in mechanistic diagnosis. (Transition zone) Validation of right ventricular pacing response during SVT in mechanistic diagnosis. (Transition zone) By Marwan Sayed Assistant lecturer Cardiology department Assiut University Under supervision of Prof

More information

EHRA Accreditation Exam - Sample MCQs Invasive cardiac electrophysiology

EHRA Accreditation Exam - Sample MCQs Invasive cardiac electrophysiology EHRA Accreditation Exam - Sample MCQs Invasive cardiac electrophysiology Dear EHRA Member, Dear Colleague, As you know, the EHRA Accreditation Process is becoming increasingly recognised as an important

More information

a lecture series by SWESEMJR

a lecture series by SWESEMJR Arrhythmias Automaticity- the ability to depolarize spontaneously. Pacemakers: Sinoatrial node: 70 bpm AV-nodal area: 40 bpm His-Purkinje: 20-40 bpm it Mechanisms of arrhythmias 1. Increased automaticity

More information

Atrial Fibrillation and Common Supraventricular Tachycardias. Sunil Kapur MD

Atrial Fibrillation and Common Supraventricular Tachycardias. Sunil Kapur MD Atrial Fibrillation and Common Supraventricular Tachycardias Sunil Kapur MD Cardiac Electrophysiology Brigham and Women s Hospital Instructor, Harvard Medical School No disclosures Cardiac Conduction:

More information

We are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists. International authors and editors

We are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists. International authors and editors We are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists 3,500 108,000 1.7 M Open access books available International authors and editors Downloads Our

More information

Paroxysmal Supraventricular Tachycardia PSVT.

Paroxysmal Supraventricular Tachycardia PSVT. Atrial Tachycardia; is the name for an arrhythmia caused by a disorder of the impulse generation in the atrium or the AV node. An area in the atrium sends out rapid signals, which are faster than those

More information

Huseng Vefali MD St. Luke s University Health Network Department of Cardiology

Huseng Vefali MD St. Luke s University Health Network Department of Cardiology Huseng Vefali MD St. Luke s University Health Network Department of Cardiology Learning Objectives Establish Consistent Approach to Interpreting ECGs Review Essential Cases for Paramedics and first responders

More information

Conventional Mapping. Introduction

Conventional Mapping. Introduction Conventional Mapping Haitham Badran Ain Shams University it Introduction The mapping approach used to guide ablation depends on the type of arrhythmia being assessed. Simple fluoroscopic anatomy is essential

More information

COMPLEX CASE STUDY INNOVATIVE COLLECTIONS. Case presentation

COMPLEX CASE STUDY INNOVATIVE COLLECTIONS. Case presentation The Journal of Innovations in Cardiac Rhythm Management, 3 (2012), 939 943 INNOVATIVE COLLECTIONS COMPLEX CASE STUDY Subtle Changes in Electrogram Morphology During Para-Hisian Pacing Performed on IV Adenosine:

More information

ECGs on the acute admission ward. - Cardiology Update -

ECGs on the acute admission ward. - Cardiology Update - ECGs on the acute admission ward - Cardiology Update - Dr Simon Fynn Consultant Cardiologist Papworth Hospital, Cambridge RCP London Oct 2017 ECG 1 1. AF with BBB 2. Pre-excited AF 3. SVT with BBB 4.

More information

A request for a log book extension must be put in writing and sent to BHRS, Unit 6B, Essex House, Cromwell Business Park, Chipping Norton,

A request for a log book extension must be put in writing and sent to BHRS, Unit 6B, Essex House, Cromwell Business Park, Chipping Norton, 7 7. A request for a log book extension must be put in writing and sent to BHRS, Unit 6B, Essex House, Cromwell Business Park, Chipping Norton, Oxfordshire OX7 5SR. E-mail: admin@bhrs.com. Tel: 01789 867

More information

Pediatrics ECG Monitoring. Pediatric Intensive Care Unit Emergency Division

Pediatrics ECG Monitoring. Pediatric Intensive Care Unit Emergency Division Pediatrics ECG Monitoring Pediatric Intensive Care Unit Emergency Division 1 Conditions Leading to Pediatric Cardiology Consultation 12.7% of annual consultation Is arrhythmias problems Geggel. Pediatrics.

More information

EPS Case presentation Looks like VT but it isn t!

EPS Case presentation Looks like VT but it isn t! EPS Case presentation Looks like VT but it isn t! E. Συμεωνίδου, MD, PhD Β Παν Καρδιολογική κλινική, Νοσ Aττικόν Σεμινάρια Ομάδων Εργασίας ΕΚΕ 2016 Ιωάννινα Disclosures I have no conflict of interest to

More information

Clinical Cardiac Electrophysiology

Clinical Cardiac Electrophysiology Clinical Cardiac Electrophysiology Certification Examination Blueprint Purpose of the exam The exam is designed to evaluate the knowledge, diagnostic reasoning, and clinical judgment skills expected of

More information

Incessant Tachycardia Using a Concealed Atrionodal Bypass Tract

Incessant Tachycardia Using a Concealed Atrionodal Bypass Tract 191 Incessant Tachycardia Using a Concealed Atrionodal Bypass Tract ADAM ZIVIN, M.D., atid FRED MORADY, M.D. From the Division of Cardiology. Department of Internal Medicine, University of Michigan Medical

More information

ECGs and Arrhythmias: Family Medicine Board Review 2009

ECGs and Arrhythmias: Family Medicine Board Review 2009 Rate Rhythm Intervals Hypertrophy ECGs and Arrhythmias: Family Medicine Board Review 2009 Axis Jess (Fogler) Waldura, MD University of California, San Francisco walduraj@nccc.ucsf.edu Ischemia Overview

More information

Emergency Medical Training Services Emergency Medical Technician Paramedic Program Outlines Outline Topic: WPW Revised: 11/2013

Emergency Medical Training Services Emergency Medical Technician Paramedic Program Outlines Outline Topic: WPW Revised: 11/2013 Emergency Medical Training Services Emergency Medical Technician Paramedic Program Outlines Outline Topic: WPW Revised: 11/2013 Wolff-Parkinson-White syndrome (WPW) is a syndrome of pre-excitation of the

More information

How To Think About Rhythms and Conduction

How To Think About Rhythms and Conduction How To Think About Rhythms and Conduction Frank Yanowitz, MD Professor of Medicine (Cardiology) University of Utah School of Medicine Medical Director, IHC ECG Services Intermountain Healthcare http://ecg.utah.edu

More information

Pre-excited tachycardia: Atrial tachycardia with a bystander left lateral accessory pathway

Pre-excited tachycardia: Atrial tachycardia with a bystander left lateral accessory pathway Pre-excited tachycardia: Atrial tachycardia with a bystander left lateral accessory pathway Jeffrey Munro, DO, Win-Kuang Shen, MD, FHRS, Komandoor Srivathsan, MD From the Department of Cardiovascular Disease,

More information

CLINICAL CARDIAC ELECTROPHYSIOLOGY Maintenance of Certification (MOC) Examination Blueprint

CLINICAL CARDIAC ELECTROPHYSIOLOGY Maintenance of Certification (MOC) Examination Blueprint CLINICAL CARDIAC ELECTROPHYSIOLOGY Maintenance of Certification (MOC) Examination Blueprint ABIM invites diplomates to help develop the Clinical Cardiac Electrophysiology MOC exam blueprint Based on feedback

More information

CATHETER ABLATION FOR TACHYCARDIAS

CATHETER ABLATION FOR TACHYCARDIAS 190 CATHETER ABLATION FOR TACHYCARDIAS MASOOD AKHTAR, M.D. T ACHY ARRHYTHMIAS constitute a major cause of mortality and morbidity. The most serious manifestation of cardiac arrhythmia is sudden cardiac

More information

the ECG, 6 mg of intravenous adenosine was administered as a fast bolus through a large bore intravenous cannula in

the ECG, 6 mg of intravenous adenosine was administered as a fast bolus through a large bore intravenous cannula in (arrows). Electrocardiography Series Singapore Med.1 2011, 52(3) 146 CME Article Regular narrow complex tachycardia Singh D, Teo S G, Poh K K V Hr JL1 11 VL VF WA, Fig. I ECG shows regular narrow complex

More information

Evaluation and Initial Treatment of Supraventricular Tachycardia

Evaluation and Initial Treatment of Supraventricular Tachycardia T h e n e w e ngl a nd j o u r na l o f m e dic i n e clinical practice Evaluation and Initial Treatment of Supraventricular Tachycardia Mark S. Link, M.D. This Journal feature begins with a case vignette

More information

Title. CitationJournal of Electrocardiology, 39(4): Issue Date Doc URL. Type. File Information. coronary sinus ostium

Title. CitationJournal of Electrocardiology, 39(4): Issue Date Doc URL. Type. File Information. coronary sinus ostium Title Nonreentrant atrioventricular nodal tachycardia due coronary sinus ostium Author(s)Yokoshiki, Hisashi; Sasaki, Koji; Shimokawa, Junichi CitationJournal of Electrocardiology, 39(4): 395-399 Issue

More information

Case Report Simultaneous Accessory Pathway and AV Node Mechanical Block

Case Report Simultaneous Accessory Pathway and AV Node Mechanical Block 185 Case Report Simultaneous Accessory Pathway and AV Node Mechanical Block Daniel Garofalo, MD, FRACP, Alfonso Gomez Gallanti, MD, David Filgueiras Rama, MD, Rafael Peinado Peinado, PhD, FESC Unidad de

More information

Bernard Belhassen, MD; Roman Fish, MD; Sami Viskin, MD; Aharon Glick, MD; Michael Glikson, MD; Michael Eldar, MD

Bernard Belhassen, MD; Roman Fish, MD; Sami Viskin, MD; Aharon Glick, MD; Michael Glikson, MD; Michael Eldar, MD www.ipej.org 3 Original Article Incidence of Dual AV Node Physiology Following Termination of AV Nodal Reentrant Tachycardia by Adenosine-5'-Triphosphate: A Comparison with Drug Administration in Sinus

More information

PARA-HISSIAN CONCEALED ACCESSORY PATHWAY

PARA-HISSIAN CONCEALED ACCESSORY PATHWAY PARA-HISSIAN CONCEALED ACCESSORY PATHWAY Anamnestic Findings 41 y.o. man with normal cardiac findings on echocardiography, suffering for paroxysmal supra-ventricular tachycardia since 1982 with rapid onset

More information

2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia

2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia Accepted Manuscript 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia Richard L. Page, MD, FACC, FAHA, FHRS, Chair, Writing Committee Member, José A. Joglar,

More information

Author's Accepted Manuscript

Author's Accepted Manuscript Author's Accepted Manuscript 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia Richard L. Page MD, FACC, FAHA, FHRS, José A. Joglar MD, FACC, FAHA, FHRS,

More information

New Criteria during Right Ventricular Pacing to Determine the Mechanism of. Supraventricular Tachycardia

New Criteria during Right Ventricular Pacing to Determine the Mechanism of. Supraventricular Tachycardia New Criteria during Right Ventricular Pacing to Determine the Mechanism of Supraventricular Tachycardia Running title: AlMahameed et al.; New criteria to determine SVT mechanism Soufian T. AlMahameed,

More information

Utility of Atrial and Ventricular Cycle Length Variability in Determining the Mechanism of Paroxysmal Supraventricular Tachycardia

Utility of Atrial and Ventricular Cycle Length Variability in Determining the Mechanism of Paroxysmal Supraventricular Tachycardia 698 Utility of Atrial and Ventricular Cycle Length Variability in Determining the Mechanism of Paroxysmal Supraventricular Tachycardia THOMAS C. CRAWFORD, M.D., SIDDHARTH MUKERJI, M.D., ERIC GOOD, D.O.,

More information

Cardiology Flash Cards

Cardiology Flash Cards Cardiology Flash Cards EKG in a nut shell www.brain101.info Conduction System www.brain101.info 2 Analyzing EKG Step by step Steps in Analyzing ECG'S 1. Rhythm: - Regular _ Sinus, Junctional or Ventricular.

More information

1 Cardiology Acute Care Day 22 April 2013 Arrhythmia Tutorial Course Material

1 Cardiology Acute Care Day 22 April 2013 Arrhythmia Tutorial Course Material 1 Cardiology Acute Care Day 22 April 2013 Arrhythmia Tutorial Course Material Arrhythmia recognition This tutorial builds on the ECG lecture and provides a framework for approaching any ECG to allow the

More information

AV Node Dependent SVT:Substrates, Mechanisms, and Recognition

AV Node Dependent SVT:Substrates, Mechanisms, and Recognition AV Node Dependent SVT:Substrates, Mechanisms, and Recognition Ching-Tai Tai Taipei Veterans General Hospital National Yang-Ming University AV Node Reentry Anatomy Physiology Anatomic-Physiologic Relation

More information

2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia

2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia Page RL, et al. 2015 ACC/AHA/HRS SVT Guideline 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia A Report of the American College of Cardiology/American

More information

Measuring the refractory period threshold of AV-node after Radiofrequency ablation

Measuring the refractory period threshold of AV-node after Radiofrequency ablation J. Appl. Environ. Biol. Sci., 6(3)146-151, 2016 2016, TextRoad Publication ISSN: 2090-4274 Journal of Applied Environmental and Biological Sciences www.textroad.com Measuring the refractory period threshold

More information

Case 1 Left Atrial Tachycardia

Case 1 Left Atrial Tachycardia Case 1 Left Atrial Tachycardia A 16 years old woman was referred to our institution because of recurrent episodes of palpitations and dizziness despite previous ablation procedure( 13 years ago) of postero-septal

More information

Concise Review for Primary-Care Physicians

Concise Review for Primary-Care Physicians Concise Review for Primary-Care Physicians Narrow QRS Complex Tachycardias STEPHEN J. PIEPER, M.D., AND MARSHALL S. STANTON, M.D. Regular narrow QRS complex tachycardias are a common problem encountered

More information

Asymptomatic WPW Syndrome; Observation or Ablation? 전남대학교병원순환기내과 박형욱

Asymptomatic WPW Syndrome; Observation or Ablation? 전남대학교병원순환기내과 박형욱 Asymptomatic WPW Syndrome; Observation or Ablation? 전남대학교병원순환기내과 박형욱 Let It Be? Vs. Just Do It? Natural history of asymptomatic WPW Incidence of sudden cardiac death in natural history studies involving

More information

Sustained tachycardia with wide QRS

Sustained tachycardia with wide QRS Sustained tachycardia with wide QRS Courtesy from Prof. Antonio Américo Friedmann. Electrocardiology Service of University of Faculty of São Paulo. Opinions from colleagues Greetings to everyone, In a

More information

Case #1. 73 y/o man with h/o HTN and CHF admitted with dizziness and SOB Treated for CHF exacerbation with Lasix Now HR 136

Case #1. 73 y/o man with h/o HTN and CHF admitted with dizziness and SOB Treated for CHF exacerbation with Lasix Now HR 136 Tachycardias Case #1 73 y/o man with h/o HTN and CHF admitted with dizziness and SOB Treated for CHF exacerbation with Lasix Now HR 136 Initial Assessment Check Telemetry screen if pt on tele Telemetry

More information

EHRA Accreditation Exam - Sample MCQs Cardiac Pacing and ICDs

EHRA Accreditation Exam - Sample MCQs Cardiac Pacing and ICDs EHRA Accreditation Exam - Sample MCQs Cardiac Pacing and ICDs Dear EHRA Member, Dear Colleague, As you know, the EHRA Accreditation Process is becoming increasingly recognised as an important step for

More information

Emerging Trends in Critical Card Nursing Symposium GSLC AACCN March 17, Marye J. Gleva M.D. F.A.C.C. F.H.R.S. Professor of Medicine

Emerging Trends in Critical Card Nursing Symposium GSLC AACCN March 17, Marye J. Gleva M.D. F.A.C.C. F.H.R.S. Professor of Medicine Understanding the ECG in Arrhythmias and Pacemakers: A Case Based Approach Emerging Trends in Critical Card Nursing Symposium GSLC AACCN March 17, 2017 Marye J. Gleva M.D. F.A.C.C. F.H.R.S. Professor of

More information

ECGs and Arrhythmias: Family Medicine Board Review 2012

ECGs and Arrhythmias: Family Medicine Board Review 2012 Overview ECGs and Arrhythmias: Family Medicine Board Review 2012 Jess Waldura, MD University of California, San Francisco walduraj@nccc.ucsf.edu Bundle branch blocks Quick review of ischemia Arrhythmias

More information

Concealed Accessory Pathway in Late Presentation Wolff-Parkinson-White Syndrome

Concealed Accessory Pathway in Late Presentation Wolff-Parkinson-White Syndrome CASE REPORT Concealed Accessory Pathway in Late Presentation Wolff-Parkinson-White Syndrome Stephanie Rose1, Richard Armstrong2, David Moore2 Third year medicine, Trinity College Dublin Department of Cardiology,

More information

ARTICLE. Supraventricular Tachycardia in Infancy. Catherine D. DeAngelis, MD. In most infants, SVT is due to an accessory atrioventricular

ARTICLE. Supraventricular Tachycardia in Infancy. Catherine D. DeAngelis, MD. In most infants, SVT is due to an accessory atrioventricular Supraventricular Tachycardia in Infancy Evaluation, Management, and Follow-up Susan P. Etheridge, MD; Victoria E. Judd, MD ARTICLE Background: Supraventricular tachycardia (SVT) occurs frequently in infancy.

More information

Original Article. Electrophysiological Features Differentiating the Atypical Atrioventricular Node Dependent Long RP Supraventricular Tachycardias

Original Article. Electrophysiological Features Differentiating the Atypical Atrioventricular Node Dependent Long RP Supraventricular Tachycardias Original Article Electrophysiological Features Differentiating the Atypical Atrioventricular Node Dependent Long RP Supraventricular Tachycardias Reginald T. Ho, MD, FHRS; Daniel R. Frisch, MD; Behzad

More information

Adenosine Mapping for Adenosine-Dependent Accessory Pathway Ablation

Adenosine Mapping for Adenosine-Dependent Accessory Pathway Ablation Adenosine Mapping for Adenosine-Dependent Accessory Pathway Ablation MARTIN J. LAPAGE, M.D., M.S.,* MICHAEL J. WALSH, M.D., JOHN H. REED, M.D., M.P.H., and J. PHILIP SAUL, M.D. From the *Department of

More information

ARRHYTHMIAS IN THE ICU

ARRHYTHMIAS IN THE ICU ARRHYTHMIAS IN THE ICU Nora Goldschlager, MD MACP, FACC, FAHA, FHRS SFGH Division of Cardiology UCSF IDENTIFIED VARIABLES IN ARRHYTHMOGENESIS Ischemia/infarction (scar) Electrolyte imbalance Proarrhythmia

More information

ARRHYTHMIAS IN THE ICU: DIAGNOSIS AND PRINCIPLES OF MANAGEMENT

ARRHYTHMIAS IN THE ICU: DIAGNOSIS AND PRINCIPLES OF MANAGEMENT ARRHYTHMIAS IN THE ICU: DIAGNOSIS AND PRINCIPLES OF MANAGEMENT Nora Goldschlager, M.D. MACP, FACC, FAHA, FHRS SFGH Division of Cardiogy UCSF CLINICAL VARIABLES IN ARRHYTHMOGENESIS Ischemia/infarction (scar)

More information

Ventriculoatrial Block During a Narrow-QRS Tachycardia: What Is the Tachycardia Mechanism? IV

Ventriculoatrial Block During a Narrow-QRS Tachycardia: What Is the Tachycardia Mechanism? IV 174 ARRHYTHMIA OF THE MONTH Section Editor: Fred Morady, M.D. Ventriculoatrial Block During a Narrow-QRS Tachycardia: What Is the Tachycardia Mechanism? IV FRED MORADY, M.D. From the Cardiology Division,

More information

Case Report Atrioventricular Nodal Re-entry Tachycardia in Identical Twins: A Case Report and Literature Review

Case Report Atrioventricular Nodal Re-entry Tachycardia in Identical Twins: A Case Report and Literature Review www.ipej.org 45 Case Report Atrioventricular Nodal Re-entry Tachycardia in Identical Twins: A Case Report and Literature Review Walid Barake MD MBBCh, Jane Caldwell BSc MBChB PhD, Adrian Baranchuk MD,

More information

Supraventricular Arrhythmias. Reading Assignment. Chapter 5 (p17-30)

Supraventricular Arrhythmias. Reading Assignment. Chapter 5 (p17-30) Supraventricular Arrhythmias Reading Assignment Chapter 5 (p17-30) The Supraventricular Rhythms In Our Lives Site of Origin Single Events Slow Rates Intermediate Rates Fast Rates (>100 bpm) Sinus Sinus

More information

Narrow QRS complex tachycardias rhythms with a

Narrow QRS complex tachycardias rhythms with a Dmitriy Kireyev, MD, FACC; Stanley F. Fernandez, MD; Vipul Gupta, MD, MPH; Mikhail V. Arkhipov, MD; Joseph A. Paris, MD, FACC Cambridge Health Alliance, Whidden Memorial Hospital, Everett, Mass (Dr. Kireyev);

More information

Nathan Cade, MD Brandon Fainstad, MD Andrew Prouse, MD

Nathan Cade, MD Brandon Fainstad, MD Andrew Prouse, MD Nathan Cade, MD Brandon Fainstad, MD Andrew Prouse, MD OBJECTIVES 1. Identify the basic electrophysiology of the four causes of wide complex tachycardia. 2. Develop a simple framework for acute management

More information

Step by step approach to EKG rhythm interpretation:

Step by step approach to EKG rhythm interpretation: Sinus Rhythms Normal sinus arrhythmia Small, slow variation of the R-R interval i.e. variation of the normal sinus heart rate with respiration, etc. Sinus Tachycardia Defined as sinus rhythm with a rate

More information

You Don t Want to Miss This One! Focus on can t miss EKG tracings

You Don t Want to Miss This One! Focus on can t miss EKG tracings You Don t Want to Miss This One! Focus on can t miss EKG tracings Renaissance St. Louis Grand Hotel Convention Center October 23, 2014 David K. Tan, M.D., EMT-T, FAAEM EMS Section Chief, Division of Emergency

More information

Debate: Asymptomatic Patients with Ventricular Preexcitation Require EP Testing for Risk Stratification. Carlo Pappone, MD, PhD, FACC

Debate: Asymptomatic Patients with Ventricular Preexcitation Require EP Testing for Risk Stratification. Carlo Pappone, MD, PhD, FACC Debate: Asymptomatic Patients with Ventricular Preexcitation Require EP Testing for Risk Stratification Carlo Pappone, MD, PhD, FACC The Wolff-Parkinson-White Syndrome Demographics Δ waves detectable on

More information

EP WIRE on Management Preexcitation syndromes

EP WIRE on Management Preexcitation syndromes EP WIRE on Management Preexcitation syndromes 1. Is your Institution: A University Hospital 70.7% 41 A Private Hospital 13.8% 8 Other Type of Hospital 15.5% 9 Institution name: 50 answered question 58

More information

«Aσθενής με ασυμπτωματικό WPW και παροξυσμική κολπική μαρμαρυγή» Χάρης Κοσσυβάκης Επιμελητής A Καρδιολογικό Τμήμα Γ.Ν.Α. «Γ.

«Aσθενής με ασυμπτωματικό WPW και παροξυσμική κολπική μαρμαρυγή» Χάρης Κοσσυβάκης Επιμελητής A Καρδιολογικό Τμήμα Γ.Ν.Α. «Γ. «Aσθενής με ασυμπτωματικό WPW και παροξυσμική κολπική μαρμαρυγή» Χάρης Κοσσυβάκης Επιμελητής A Καρδιολογικό Τμήμα Γ.Ν.Α. «Γ. ΓΕΝΝΗΜΑΤΑΣ» the primary mechanism of SCD in patients with WPW is the rapid conduction

More information

II V 1 HRA 3 4 HB 5 6 HB 3 4 HB 1 2 CS 7 8 CS 5 6 CS 3 4 CS 1 2 ABL 3 4 ABL 1 2 RVA 3 4. T. Suga et al.

II V 1 HRA 3 4 HB 5 6 HB 3 4 HB 1 2 CS 7 8 CS 5 6 CS 3 4 CS 1 2 ABL 3 4 ABL 1 2 RVA 3 4. T. Suga et al. Table 1. The distance between the positions of the catheter tip Patient Location Before elimination of After elimination of Number of the the accessory pathway the accessory pathway accessory pathway RAO

More information

Differentiating Junctional Tachycardia and Atrioventricular Node Re-Entry Tachycardia Based on Response to Atrial Extrastimulus Pacing

Differentiating Junctional Tachycardia and Atrioventricular Node Re-Entry Tachycardia Based on Response to Atrial Extrastimulus Pacing Journal of the American College of Cardiology Vol. 52, No. 21, 2008 2008 by the American College of Cardiology Foundation ISSN 0735-1097/08/$34.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2008.08.030

More information

REtrive. REpeat. RElearn Design by. Test-Enhanced Learning based ECG practice E-book

REtrive. REpeat. RElearn Design by. Test-Enhanced Learning based ECG practice E-book Test-Enhanced Learning Test-Enhanced Learning Test-Enhanced Learning Test-Enhanced Learning based ECG practice E-book REtrive REpeat RElearn Design by S I T T I N U N T H A N G J U I P E E R I Y A W A

More information

APPROACH TO TACHYARRYTHMIAS

APPROACH TO TACHYARRYTHMIAS APPROACH TO TACHYARRYTHMIAS PROF.DR.MD.ZAKIR HOSSAIN PROFESSOR AND HEAD DEPARTMENT OF MEDICINE SZMCH TACHYARRYTHMIA Cardiac arrythmia is a disturbance of electrical rhythm of heart. Cardac arrythmia with

More information

How to Ablate Atrial Tachycardia Mechanisms and Approach. DrJo Jo Hai

How to Ablate Atrial Tachycardia Mechanisms and Approach. DrJo Jo Hai How to Ablate Atrial Tachycardia Mechanisms and Approach DrJo Jo Hai Contents Mechanisms of focal atrial tachycardia Various mapping techniques Detailed discussion on activation sequence mapping and entrainment

More information

Premature Atrial Contractions Managed With Slow Pathway Ablation

Premature Atrial Contractions Managed With Slow Pathway Ablation Maced J Med Sci electronic publication ahead of print, published on November 25, 2008 as doi:10.3889/mjms.1857-5773.2008.0018 Trajkov et al. Slow Pathway Ablation Macedonian Journal of Medical Sciences.

More information

Ankara, Turkey 2 Department of Cardiology, Division of Arrhythmia and Electrophysiology, Yuksek Ihtisas

Ankara, Turkey 2 Department of Cardiology, Division of Arrhythmia and Electrophysiology, Yuksek Ihtisas 258 Case Report Electroanatomic Mapping-Guided Radiofrequency Ablation of Adenosine Sensitive Incessant Focal Atrial Tachycardia Originating from the Non-Coronary Aortic Cusp in a Child Serhat Koca, MD

More information

How to ablate typical slow/fast AV nodal reentry tachycardia

How to ablate typical slow/fast AV nodal reentry tachycardia Europace (2000) 2, 15 19 Article No. eupc.1999.0070, available online at http://www.idealibrary.com on OW TO... SERIES ow to ablate typical slow/fast AV nodal reentry tachycardia. eidbüchel Department

More information

Journal of the American College of Cardiology Vol. 33, No. 3, by the American College of Cardiology ISSN /99/$20.

Journal of the American College of Cardiology Vol. 33, No. 3, by the American College of Cardiology ISSN /99/$20. Journal of the American College of Cardiology Vol. 33, No. 3, 1999 1999 by the American College of Cardiology ISSN 0735-1097/99/$20.00 Published by Elsevier Science Inc. PII S0735-1097(98)00614-7 A Technique

More information

On Discovery. Pediatric Electrophysiology D CO. Electrophysiology. University of Texas Health Science Center at San Antonio, Texas

On Discovery. Pediatric Electrophysiology D CO. Electrophysiology. University of Texas Health Science Center at San Antonio, Texas Pediatric Electrophysiology David M Bush, MD, PhD ssistant Professor of Pediatrics Children s Heart Network Center San ntonio On Discovery What is wanted is not the will to believe, but the will to find

More information

I have no conflicts of interest relative to this lecture.

I have no conflicts of interest relative to this lecture. PATHWAYS AROUND THE PITFALLS OF EKG RHYTHM INTERPRETATION Donald D. Brown, MD April 4, 2019 I have no conflicts of interest relative to this lecture. OBJECTIVES FOR PATHWAYS AROUND PITFALLS OF EKG RHYTHM

More information

Unusual Tachycardia Association In A patient Without Structural Heart Disease

Unusual Tachycardia Association In A patient Without Structural Heart Disease www.ipej.org 233 Case Report Unusual Tachycardia Association In A patient Without Structural Heart Disease Eduardo Arana-Rueda, Alonso Pedrote, Lorena Garcia-Riesco, Manuel Frutos-Lopez, Juan A. Sanchez-Brotons

More information

EKG Abnormalities. Adapted from:

EKG Abnormalities. Adapted from: EKG Abnormalities Adapted from: http://www.bem.fi/book/19/19.htm Some key terms: Arrhythmia-an abnormal rhythm or sequence of events in the EKG Flutter-rapid depolarizations (and therefore contractions)

More information

Double Retrograde Atrial Response After Radiofrequency. ablation of typical AV nodal tieentrant tachycardia

Double Retrograde Atrial Response After Radiofrequency. ablation of typical AV nodal tieentrant tachycardia Double Retrograde Atrial Response After Radiofrequency Ablation of Typical AV Nodal Reentrant Tachycardia STEVEN J. KALBFLEISCH, M.D., S. ADAM STRICKBERGER, M.D.. JOHN D. HUMMEL, M.D., BRIAN D. WILLIAMSON,

More information