EP 101

EP Quiz

Ulhas M. Pandurangi, MD, Chief - Cardiac Electrophysiology & Pacing, The Madras Medical Mission, Mogappair, Chennai, India

Ulhas M. Pandurangi, MD, Chief - Cardiac Electrophysiology & Pacing, The Madras Medical Mission, Mogappair, Chennai, India

Question #1:

The maneuver rules out :

  1. AVNRT.
  2. Left posteroseptal pathway.
  3. Atrial tachycardia.
  4. None of the above.

Question #2:

The most likely diagnosis is:

  1. RVOT PVC – Couplets.
  2. Rate-related LBBB. 
  3. RVOT PVC – Couplets and rate-related LBBB.
  4. None of the above.

Answer to Question #1:

Atrial tachycardia.

The last ventricular paced beat resulted in VAHV response with continuation of tachycardia.

Answer to Question #2:

Rate-related LBBB.

PVCs are from LVOT, RS in V1 (single arrow). The wide QRS beat in sinus rhythm is due to LBBB (double arrow). The narrow QRS sinus beat follows a pause. On ablation of the PVCs, the pause is eliminated and rate-related LBBB manifests.