The era of catheter ablation for the treatment of arrhythmias began in 1981 when Dr. Melvin Scheinman performed the first atrioventricular junction ablation using direct current shocks in a patient with drug refractory atrial fibrillation and an uncontrolled ventricular rate.1 Because of the barotrauma associated with intracardiac, high energy shocks, direct current catheter ablation played onl...

Paroxysmal supraventricular tachycardia (PSVT) has been a well-recognized clinical syndrome and an electrocardiographically defined arrhythmia since the early days of electrocardiography. The clinical syndrome was defined in European literature in the 19th century. In 1867, Cotton reported on an “unusually rapid action of the heart,” and this was followed by further observations by French and G...

A 65-year-old woman underwent an electrophysiologic procedure because of a 20-year history of paroxysmal supraventricular tachycardia. The baseline sinus cycle length was 800 msec, with an atrial-His interval (AH) of 100 msec and a His-ventricular interval (HV) of 40 msec. There was evidence of dual AV nodal pathways, but no inducible tachycardia. During infusion of isoproterenol, the sinus cyc...

The scalar and intracardiac electrocardiograms recorded at the time of cardiac catheterization in 5 patients with ventricular pre-excitation have been analysed. Four patients had paroxysmal tachycardia on one or more occasions during the procedure. In each case where complete records were available the dysrhythmia was an atrial reciprocating tachycardia and this rhythm wasnoted at some time dur...

A 15-year-old female with WPW syndrome and normal heart underwent an electrophysiology study for paroxysmal palpitations and syncope. Intravenous adenosine produced an unexpected response of QRS changes and advanced AV block. During isoproteronol infusion, short-lasting and poorly tolerated wide QRS tachycardia was inducible, but pacing maneuvers were not feasible during tachycardia to determin...

Toxicity from the digitalis family of cardiac glycoside medications remains common. Successful treatment depends on early recognition; however, the diagnosis of potentially life-threatening toxicity remains difficult because the clinical presentation is often nonspecific and subtle. The hallmark of cardiac toxicity is increased automaticity coupled with concomitant conduction delay. Though no s...

Paroxysmal supraventricular tachycardia (PSVT) is a common clinical problem. Valsalva maneuver and adenosine are effective therapies for many patients with PSVT, although any conversion to an irregular or wide complex tachycardia should prompt consideration of a preexcitation syndrome. We report a case where the Valsalva maneuver and adenosine, in a patient with PSVT and previously undiagnosed ...

A37-year-old man with frequent episodes of paroxysmal atrial fibrillation refractory to antiarrhythmic therapy (and no other documented arrhythmias on multiple Holter examinations) underwent an attempt at radiofrequency ablation of the atrial fibrillation. Catheter positions are shown in the left anterior oblique view in Figure 1 and include 2 catheters in the left and right upper pulmonary vei...

OBJECTIVE To study various types of supraventricular arrhythmias in patients with Brugada Syndrome. METHODS Forty six patients with ECG of spontaneous type Brugada and with ventricular and/or supraventricular tachyarrhythmia, without structural heart diseases which were excluded by echocardiography, underwent 24 h-Holter recording, electrophysiological study and/or radiofrequency ablation. ...

Paroxysmal tachycardia with widened QRS complexes was recorded in a 21-year-old man. In sinus rhythm there was no evidence of pre-excitation. His bundle studies revealed an abnormally short HV interval of 30 ms. Premature atrial stimuli produced an increased PR interval. At short coupling intervals the His bundle activity became incorporated within the QRS complex. Concurrently, a left bundle-b...