Images and Case Reports in Arrhythmia and Electrophysiology Wenckebach During Supraventricular Tachycardia
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چکیده
In case 1, a 71-year-old man with a history of coronary artery disease presented with recurrent paroxysmal supraventricular tachycardia (SVT) despite treatment with -blockers. During electrophysiology study, the baseline sinus cycle length was 895 ms, atrial-His (AH) interval was 120 ms, and His-ventricular interval was 60 ms. A narrow complex SVT with tachycardia cycle length of 480 ms was initiated with atrial overdrive pacing at 400 ms, as well as with single atrial extrastimuli. The tachycardia showed a long RP interval with regular concentric atrial activation pattern and atrioventricular Wenckebach conduction (Figure 1). Ventricular overdrive pacing during tachycardia repeatedly terminated the tachycardia without activation of the atrium (Figure 2). In case 2, a 32-year-old woman with a history of recurrent, debilitating palpitations for more than 5 years, despite medical therapy, was referred after 4 electrophysiology studies and unsuccessful ablations. At electrophysiology study, multipolar catheters were placed in the right atrium, His-bundle region, right ventricle, and coronary sinus. At baseline, the patient was found to be in normal sinus rhythm, without evidence of preexcitation, and she had normal AH and His-ventricular intervals. During catheter placement, an irregular narrow-complex SVT occurred spontaneously (Figure 3). Attempts to entrain the short RP tachycardia with ventricular overdrive pacing resulted in ventriculoatrial dissociation. Multiple late atrial premature beats (APBs) were introduced during tachycardia and did not influence the tachycardia cycle length (Figure 4). In addition, the AH interval during atrial pacing in sinus rhythm, at the tachycardia cycle length, was 40 ms greater than the AH interval during tachycardia.
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تاریخ انتشار 2010