Electrophysiology Fellow

Cardiac electrophysiology fellow with an interest in the familial, words, and the history of electrophysiology.

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Historical vignette

“Die Aeltern des Kindes nachdem ihnen möglichst schonend das unglückliche Lebensende ihrer Tochter mitgetheilt worden war sich gar nicht darüber gewundert sondern geradezu geantwortet dass diese Nach nicht sie durchaus nicht befremdet habe da schon einige solche Zufälle in ihrer Familie früher vorgekommen seien em Kind war nehmlich nach einem heftigen Schreck ein zweites nach heftigem Zorn Consplötzlich todt niedergefallen"

The parents of the child were given the unhappy news of the death of their daughter. They were not surprised as this had occurred twice before: a child had died suddenly after a sudden shock, and another during a violent rage.

Friedrich Ludwig Meissner 1856

 

This is the first report of which inherited arrhythmia syndrome?

Who published the first description of this condition in association with its ECG phenotype?

 

 

Incessant supraventricular tachycardia

This young man was in this arrhythmia 80-90% of the time. He presents with an left ventricular ejection fraction of 20% and has pristine coronary arteries.

What is the differential diagnosis?

Ecgpng
 

 

Localising a (concealed) accessory pathway

We've talked before about localising accessory pathways by the characteristics of the delta wave. The question for today: can a concealed accessory pathway be localized using the surface ECG?

Here are two ECGs, one during sinus rhythm, the other during tachycardia. The differential diagnosis for the SVT is not broad. I can think of two possibilities. However, I know from an EPS study that this is a SVT using a concealed bypass tract.

What is the other possibility?

If this is an SVT using a concealed bypass tract, where is the bypass tract located?

(download)

Update: So, as mcg points out (comments) this tracing is suggestive of a left lateral accessory pathway. The differential diagnosis is atrial tachycardia, and the two cannot be differentiated on the surface ECG unless there is wobble in the tachycardia cycle length, which there is not in this case.

It is presumably concealed, but left lateral pathways with some antegrade conduction can have minimal preexcitation on the surface ECG due to delayed conduction to the atrial insertion. In this case we paced the CS catheter close to the atrial insertion without demonstrating preexcitation.