The document describes 10 cases of arrhythmias with electrocardiogram (ECG) findings. Case 1 involves paroxysmal supraventricular tachycardia (PSVT) with right bundle branch block (RBBB) and cycle length alternans due to dual atrioventricular node (AVN) physiology, consistent with orthodromic atrioventricular reentrant tachycardia (AVRT). Case 2 involves a narrow P wave indicating simultaneous right and left atrial depolarization, consistent with slow-fast AVNRT with 2:1 atrioventricular block. Case 3 demonstrates initiation of supraventricular tachycardia from normal sinus rhythm with preexcitation due to a retrograde
This document outlines techniques for differentiating supraventricular tachycardias (SVTs). It discusses features of SVT induction and baseline tachycardia characteristics, as well as diagnostic maneuvers that can be performed during tachycardia and after termination in sinus rhythm. These include the effects of atrial and ventricular extrastimulation or pacing on SVT cycle length, VA intervals, and atrial activation sequences to help identify the mechanism as atrial tachycardia, atrioventricular nodal reentrant tachycardia, or orthodromic reentrant tachycardia using an accessory atrioventricular connection. The document provides detailed descriptions and examples of applying these diagnostic tests.
The document describes 10 cases of arrhythmias with electrocardiogram (ECG) findings. Case 1 involves paroxysmal supraventricular tachycardia (PSVT) with right bundle branch block (RBBB) and cycle length alternans due to dual atrioventricular node (AVN) physiology, consistent with orthodromic atrioventricular reentrant tachycardia (AVRT). Case 2 involves a narrow P wave indicating simultaneous right and left atrial depolarization, consistent with slow-fast AVNRT with 2:1 atrioventricular block. Case 3 demonstrates initiation of supraventricular tachycardia from normal sinus rhythm with preexcitation due to a retrograde
This document outlines techniques for differentiating supraventricular tachycardias (SVTs). It discusses features of SVT induction and baseline tachycardia characteristics, as well as diagnostic maneuvers that can be performed during tachycardia and after termination in sinus rhythm. These include the effects of atrial and ventricular extrastimulation or pacing on SVT cycle length, VA intervals, and atrial activation sequences to help identify the mechanism as atrial tachycardia, atrioventricular nodal reentrant tachycardia, or orthodromic reentrant tachycardia using an accessory atrioventricular connection. The document provides detailed descriptions and examples of applying these diagnostic tests.
1) The digital ESC Congress 2020 attracted over 116,000 healthcare professionals from 211 countries, focusing on new knowledge in arrhythmias and device therapy.
2) New guidelines and studies provided updates on atrial fibrillation screening and management, showing benefits of early rhythm control and new anticoagulants.
3) Studies explored new pacing approaches like His bundle and left bundle pacing to improve effectiveness and reduce fluoroscopy time.
A meeting was held on August 10, 2019 (Saturday) in room 803 of the Taipei Chang Yung-fa International Convention Center. The meeting location and date are provided.
1) The digital ESC Congress 2020 attracted over 116,000 healthcare professionals from 211 countries, focusing on new knowledge in arrhythmias and device therapy.
2) New guidelines and studies provided updates on atrial fibrillation screening and management, showing benefits of early rhythm control and new anticoagulants.
3) Studies explored new pacing approaches like His bundle and left bundle pacing to improve effectiveness and reduce fluoroscopy time.
A meeting was held on August 10, 2019 (Saturday) in room 803 of the Taipei Chang Yung-fa International Convention Center. The meeting location and date are provided.
18. Characteristics of the 12-lead ECG duringCharacteristics of the 12-lead ECG during
the tachycardia that suggest a ventricularthe tachycardia that suggest a ventricular
origin for the arrhythmiaorigin for the arrhythmia
• AA QRS complex >0.14 sQRS complex >0.14 s in the absence ofin the absence of
antiarrhythmic therapyantiarrhythmic therapy
• AV dissociationAV dissociation (with or without fusion or(with or without fusion or
captured beats) or variable retrogradecaptured beats) or variable retrograde
conductionconduction
• AA superior QRS axissuperior QRS axis in the presence of ain the presence of a
right bundle branch block patternright bundle branch block pattern
• Concordance of the QRS patternConcordance of the QRS pattern in allin all
precordial leads (i.e., all positive or allprecordial leads (i.e., all positive or all
negative deflections)negative deflections)
• OtherOther QRS patterns (morphology)QRS patterns (morphology) withwith
prolonged duration that are inconsistentprolonged duration that are inconsistent
with typical right or left bundle branch blockwith typical right or left bundle branch block
patternspatterns
19. ECG CRITERIA THAT FAVORECG CRITERIA THAT FAVOR
VENTRICULAR TACHYCARDIAVENTRICULAR TACHYCARDIA
• AV dissociationAV dissociation
• QRS width:QRS width:
>0.14 s with RBBB>0.14 s with RBBB configurationconfiguration
>0.16 s with LBBB>0.16 s with LBBB configuration configuration
• QRS axis:QRS axis:
Left axis deviation with RBBBLeft axis deviation with RBBB
morphologymorphology Extreme left axisExtreme left axis
deviationdeviation (northwest axis)(northwest axis) with LBBBwith LBBB
morphology morphology
• Concordance of QRSConcordance of QRS in precordialin precordial
leads
Harrison's Principles of internal Medicine, 16th Edition
20. ECG CRITERIA THAT FAVORECG CRITERIA THAT FAVOR
VENTRICULAR TACHYCARDIAVENTRICULAR TACHYCARDIA
• MorphologicMorphologic
patterns of the QRSpatterns of the QRS
complex RBBB:complex RBBB:
Mono- orMono- or
biphasicbiphasic
complex in V1complex in V1
RS (RS (only withonly with
left axisleft axis
deviationdeviation)) oror QSQS
in V6in V6
• LBBB:LBBB:
Broad R wave in V1Broad R wave in V1
or V2or V2 0.04 s0.04 s
• Onset of QRS toOnset of QRS to
nadir of S wave in V1nadir of S wave in V1
or V2 ofor V2 of 0.07 s0.07 s
• NotchedNotched
downslope of Sdownslope of S
wave in V1 or V2wave in V1 or V2
• Q waveQ wave in V6in V6
Harrison's Principles of internal Medicine, 16th Edition
21. Differential Diagnosis of WideDifferential Diagnosis of Wide
Regular QRS TachcardiaRegular QRS Tachcardia
Absence of an RS complex in all precordial leads
Favor VT
Yes No
R to S interval > 100 ms in one precordial lead?
Yes
Favor VT
No
Atrio-ventricular dissociation?
Yes
Favor VT
No
Morphology criteria
Four-step AlgorithmFour-step Algorithm (by(by BrugadaBrugada et al)et al)
1
2
3
4
22. Differential Diagnosis of WideDifferential Diagnosis of Wide
Regular QRS TachcardiaRegular QRS Tachcardia
Morphology criteria for VT present both in precordial leads V1-2 and V6?
RBBB LBBB
Yes
Yes
Favor VT
Four-step AlgorithmFour-step Algorithm (by(by BrugadaBrugada et al)et al)
23.
24.
25.
26.
27.
28.
29. Polymorphic VTPolymorphic VT
Torsade de pointTorsade de point
Congenital Long QT syndromeCongenital Long QT syndrome