101. Two-to-one bundle branch block during atrioventricular nodal reentrant tachycardia: What is the mechanism?
- Author
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Helen S. Barold, Michael Flanagan, S. Serge Barold, and Matthew Newman
- Subjects
Tachycardia ,medicine.medical_specialty ,medicine.medical_treatment ,Bundle-Branch Block ,QT interval ,Electrocardiography ,QRS complex ,Heart Rate ,Physiology (medical) ,Internal medicine ,Bradycardia ,medicine ,Humans ,Tachycardia, Atrioventricular Nodal Reentry ,Sinus rhythm ,cardiovascular diseases ,Aged ,Atrial pacing ,Bundle branch block ,business.industry ,Ablation ,medicine.disease ,cardiovascular system ,Cardiology ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,NODAL - Abstract
E I A t ase presentation 79-year-old woman presented with a regular tachycardia t 160 bpm with narrow QRS complexes alternating with ight bundle branch block (RBBB) in 2:1 fashion through ost of the ECG tracing. After reversion to sinus rhythm, 2-lead ECGs showed intermittent 1:1 RBBB occurring at andom. Figure 1 was recorded during a period of transient :1 RBBB that lasted a few minutes. The RBBB (QRS uration 0.12 second) was not rate dependent (bradycaria or tachycardia). When RBBB subsided, the ECG howed left anterior hemiblock, a tiny q wave in lead V2 robably related to left anterior hemiblock. Myocardial inarction was ruled out. Echocardiography and coronary aniography were normal. Electrophysiologic study revealed typical dual AV nodal athway physiology. Rapid atrial pacing easily induced AV odal reentrant tachycardia that was easily terminated by entricular burst pacing. More than 20 induced episodes of achycardia, mostly at the same rate, all displayed 2:1 BBB (QRS 0.12 second; Figure 2). The cycle length of ll episodes of tachycardia was constant for any given pisode. The HV interval during the tachycardia was contant at 55 ms (Figure 3). The tachycardia was no longer nducible after slow pathway ablation. What was the mechnism of the 2:1 RBBB during tachycardia?
- Published
- 2007
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