Session III: Invasive Diagnosis and Treatment-6155-Workshop #5: Invasive/Noninvasive Correlation

Video Transcription

Video Summary

In the first case, the video presenter discusses a patient with wide complex tachycardia and presents the ECG tracings and intracardiac recordings during burst pacing from the right ventricular apex. The correct diagnosis is bundle branch reentrant ventricular tachycardia, determined by analyzing the surface ECG and intracardiac recordings that show evidence of fusion, activation sequence, and post-pacing interval. In the second case, the presenter discusses a patient with recurrent atrial fibrillation in response to isoproterenol. The EKG shows a triggered atrial fibrillation originating from the superior posterior wall of the left atrium. The correct site of the non-pulmonary vein trigger is the superior posterior left atrium between the isolated pulmonary veins. In the third case, the presenter discusses a patient with a wide complex tachycardia during atrial pacing 20 milliseconds faster than the tachycardia cycle length. The correct diagnosis is bundle branch reentry tachycardia, determined by the fusion seen during pacing and the post-pacing interval. In the fourth case, the presenter discusses a patient with recurrent VF episodes following acute myocardial infarction. The correct diagnosis is bundle branch reentry tachycardia, determined by the QRS morphology and the evidence of concealed fusion during entrainment. In the fifth case, the presenter discusses a patient with a history of palpitations and dyspnea. The correct diagnosis is AV reentry tachycardia, determined by the evidence of concealed entrainment during pacing and the activation sequence during tachycardia. In the sixth case, the presenter discusses a patient with ventricular tachycardia following pulmonary vein isolation. The correct diagnosis is idiopathic ventricular tachycardia, determined by the QRS morphology and the evidence of termination with pacing. In the seventh case, the presenter discusses a patient with recurrent wide complex tachycardias. The correct diagnosis is arrhythmogenic right ventricular cardiomyopathy, determined by the QRS morphology, the evidence of AV dissociation, and structural abnormalities seen in sinus rhythm. In the eighth case, the presenter discusses a patient with post-infarction ventricular tachycardia. The correct next step is to terminate the tachycardia and proceed with substrate-guided ablation, as pacing at this site has already been shown to capture and therefore ablation at this site is likely to be successful. In the ninth case, the presenter discusses a patient with non-ischemic dilated cardiomyopathy and recurrent ventricular tachycardia. The correct diagnosis is cardiac sarcoidosis, determined by the QRS morphology and evidence of scar in the lateral wall of the left ventricle.

Keywords

wide complex tachycardia

bundle branch reentrant ventricular tachycardia

ECG tracings

intracardiac recordings

fusion

activation sequence

post-pacing interval

recurrent atrial fibrillation

isoproterenol

triggered atrial fibrillation

non-pulmonary vein trigger

atrial pacing