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A 14 year old with SVT

A 14 year old with SVT. Baseline EP study. AH 60, HV 57, no preexcitation Antegrade WCL 420 Decremental with AH jump at 600/390 + echos Block with adenosine Retrograde WCL 430 Decremental with VA jump at 600/420 + echos Block with adenosine On isoproterenol, SVT #1 induced…. SVT #1.

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A 14 year old with SVT

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  1. A 14 year old with SVT

  2. Baseline EP study • AH 60, HV 57, no preexcitation • Antegrade • WCL 420 • Decremental with AH jump at 600/390 + echos • Block with adenosine • Retrograde • WCL 430 • Decremental with VA jump at 600/420 + echos • Block with adenosine • On isoproterenol, SVT #1 induced…

  3. SVT #1 • All consistent with typical AVNRT • RF slow pathway modification…

  4. Slow pathway area

  5. CS pacing 400 SVT 400 AH 60 AH 50

  6. Spontaneous

  7. 340 340 340 340 340

  8. Spontaneous

  9. SVT #2 • Diagnosis? Next steps? • Attempt at 3D mapping for adjunctive clues…

  10. Right posteroseptal

  11. Slow pathway area Slow pathway area Ineffective sites Ineffective sites ~ -60 ms

  12. Thank you!

  13. SVT #2 alone

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