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Unexpected QRS complex during atrial pacing in a patient with preexcitation:

Unexpected QRS complex during atrial pacing in a patient with preexcitation:

two-for-one & accessory pathway

two-for-one & accessory pathway

 

DOI:
http://dx.doi.org/10.5031/v1i2.RIA10105

Id:
v1i2.RIA10105

Idioma del manuscrito:
Spanish

País:
Canada

Categoría (seleccionar una categoría apropiada para el envío) :
Reporte de Casos & Imágenes en Arritmología

Palabras clave:
Ablación por catéter

Autores y títulos (Ejemplo: Fernandes C., MD, PhD, etc):
Rodrigo Miranda MD, Damian P. Redfearn MB ChB, Christopher S. Simpson MD FRCPC, Hoshiar Abdollah MB ChB, Adrian Baranchuk MD FACC

Queen's University, 76 Stuart St, Kingston
barancha@kgh.kari.net

 

Resumen en Español o Portugués

An 18-year-old man with history of palpitations and a preexcited ECG in the absence of structural heart disease was referred for electrophysiology study and potential RF ablation. Resting 12-lead surface ECG revealed sinus rhythm with short PR interval due to preexcitation. Programmed high right atrium pacing introducing extrastimuli (A1/A2) at progressively shorter coupling intervals, increased pre-excitation without change in P to delta time. Atrial coupling interval at 600/280 ms resulted in maximum preexcitation followed by a second narrow QRS complex preceded only by a His deflection and followed by eccentric retrograde atrial activation. What is the mechanism?

Resumen en Inglés

An 18-year-old man with history of palpitations and a preexcited ECG in the absence of structural heart disease was referred for electrophysiology study and potential RF ablation. Resting 12-lead surface ECG revealed sinus rhythm with short PR interval due to preexcitation. Programmed high right atrium pacing introducing extrastimuli (A1/A2) at progressively shorter coupling intervals, increased pre-excitation without change in P to delta time. Atrial coupling interval at 600/280 ms resulted in maximum preexcitation followed by a second narrow QRS complex preceded only by a His deflection and followed by eccentric retrograde atrial activation. What is the mechanism?

 

Contenido

Unexpected QRS complex during atrial pacing in a patient with preexcitation:

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