(FIT)-Module 2 Workshop 3: SVT Mechanisms and Maneuvers-Miller Workshop 3

Miller Workshop 3

Pdf Summary

Workshop #3 is presented by John M. Miller, MD, FHRS, a professor of medicine at Indiana University School of Medicine. In terms of disclosure of relationships, Dr. Miller has received compensation for services and consulting fees from various medical companies such as Medtronic, Boston Scientific Corp., and Abbott EP, among others. He has also received royalty income from Elsevier and fellowship support from Medtronic, Boston Scientific Corp., and others.<br /><br />In the first question, a 23-year-old woman is undergoing catheter ablation for Wolff-Parkinson-White syndrome. After delivering radiofrequency energy near the coronary sinus os, preexcitation gradually ceases. Based on the findings in the tracing, the RF delivery should be stopped immediately. This is because the delta wave disappears gradually due to accelerated junctional rhythm, which could lead to permanent AV nodal block.<br /><br />In question 2, a 45-year-old woman with recurrent wide QRS tachycardia undergoes an EP study. The results of the stimulation indicate that the most likely diagnosis is antidromic atrioventricular reentry.<br /><br />Question 3 presents a 49-year-old woman with episodes of tachycardia. The initiation of the tachycardia in the EP study suggests that the most likely diagnosis is orthodromic reentry using a left free wall accessory pathway.<br /><br />In question 4, a 33-year-old woman with recurrent supraventricular tachycardia undergoes an EP study. The recordings suggest that the best interpretation is orthodromic atrioventricular reentry tachycardia.<br /><br />Question 5 involves a 37-year-old man with supraventricular tachycardia. The findings from the Para-Hisian pacing are most consistent with conduction over the AV node and a left-sided accessory pathway.<br /><br />Lastly, question 6 presents a 13-year-old girl with palpitations and lightheadedness. The recordings indicate that the findings are most consistent with an atrioventricular pathway.

Keywords

Wolff-Parkinson-White syndrome

catheter ablation

radiofrequency energy

accelerated junctional rhythm

AV nodal block

antidromic atrioventricular reentry

orthodromic reentry

left free wall accessory pathway

supraventricular tachycardia

Para-Hisian pacing