Session IV: Noninvasive Diagnosis and Treatment-6156-Workshop #6- Electrocardiographic-Electrophysiological Correlations

Video Transcription

Video Summary

The patient in the case presented with palpitations and chest pain. An ECG was obtained and showed a wide complex tachycardia. Adenosine was given and resulted in termination of the tachycardia. An analysis of the ECG showed a fusion beat, where the atrial and ventricular signals overlapped, indicating that the tachycardia was not pure atrioventricular (AV) nodal reentrant tachycardia. In addition, ventricular extrastimulation testing showed no change in the atrial activation sequence when an extrastimulus was delivered, suggesting that the patient had accessory pathway-mediated tachycardia rather than AV nodal reentrant tachycardia. Another case involved a patient with mitral annular disjunction and chest pain and syncope. The ECG showed ST depression and tombstoning, indicating potential coronary artery spasm. The most likely diagnosis in this case was coronary artery spasm associated with mitral annular disjunction. Another case discussed retrograde conduction during catheter ablation procedures. Retrograde right bundle branch block indicated accessory pathway-mediated tachycardia rather than AV nodal reentrant tachycardia. Finally, a case involved a patient with tachycardia and a His-P wave pattern seen on the intracardiac electrogram. Ventricular extrastimulation testing showed a PAC from the distal CS could pre-excite the ventricle without changing the timing or sequence of atrial activation. This suggested accessory pathway-mediated tachycardia rather than AV nodal reentrant tachycardia.

Keywords

palpitations

chest pain

ECG

wide complex tachycardia

adenosine

fusion beat

accessory pathway-mediated tachycardia

AV nodal reentrant tachycardia

mitral annular disjunction

coronary artery spasm