Syamkumar William H. Sauer, MD Gustavo Costa It was a left posterior AP. We practice the maneuver to be familiar with it and use it when appropriate. It is always nice to practice maneuvers to have confidence.

“The Aborted Coumel Sign” Pleased to meet you! Recently, I’ve posted a WCT that was terminated w/narrow complex QRS in a treadmill test. We weren’t able to reproduce it in the EPS but our thoughts were right. It was a left sided AP Today in other #WPW RFA the sign was seen.

It is really easy to understand. WCT has a longer VA than NCT. When LBBB resolves, VA is shorter and AH longer, producing AV block after first beat after QRS normalization. In this case, there is no His. Measurements are made from CS no QRS onset.

His-refractory PVC delivered from LV. RV dissociation in ORT using a left posterior AP. RV TCL remained unchanged. Case from today at Hospital Posadas This is the forth patient included and we can reproduce this phenomenon in all cases.

#WPW Slanted Left posteroseptal AP. Case from last week. Assessment of oblique course of AP during Sinus Rhythm and V pacing. There is a mismatch in earliest A EGM during V pacing and V far field EGM during Sinus Rhythm. This will make you know where to aim the RFA.

RFA performed close to V insertion mapping the earliest V during sinus rhythm at posteroseptal level as depicted in sinus rhythm EGM. Ablation catheter is not at earliest A during V pacing. All starts with EGM analysis. Success at first session.

SVT in the lab. Unable to entrain. Can you tell a diagnosis ? Let’s try #fellowsfirst Koichi Nagashima@EP Univ. Ablation School Gustavo Costa Hospital posadas

MASA Koichi Nagashima@EP Univ. Ablation School Gustavo Costa Hospital Anyway, a single HRPVC can make the diagnosis.

6 yof pt w/AVNRT. Patient under GA. Junctional rhythm most of the time. Spontaneous AVNRT onset with 2:1 conduction. There is no PACs to beget the reentrant circuit in the AVN. I find this is a complete dissociation of SP/FP to this kind of onset. I’ve never seen this before.

Atypical accessory pathway connection between RAA-RV. A nice tip here is to recognize what we coined “fan effect”: a remote place depolarizes HRA-HIS-CSp almost at same time in ORT Successful RFA at 3rd session. Hospital Posadas

Entrainment from RV rules out Atrial Tachycardia (VAV response) Very short returning cycle rules out AVNRT

Successful EGM. Look how early compared to His Channel, the earliest Atrium depolarization in the tricuspid ring. RAA base location. Ablation ON Session 3

Successful RFA session 3. VA dissociation achieved at RAA base.

VA block in AP during RFA.

For ECG lovers. ORT with big retrograde P waves in inferior leads. These are the tallest retrograde P waves in ORT I have ever seen in inferior leads.

45 yo male, morbid obesity w/ PMHx of WPW syndrome & documented regular WCT. Antidromic Reentrant tachycardia (ART) using a left lateral AP as anterograde limb & AVN as retrograde limb. Duodromic tach w/presence of septal AP r/o w/pacing maneuvers Retro AV conduction 260 ms

29 yof PMHx of documented SVT c/w AVNRT not Inducible in the lab. 2nd case in a row. RFA performed during SR>RR phenomenon. “Inverted AVN Wenckebach sign” This is due to successful RFA of slow pathway of AVN Done with Kamila Olivera & Gustavo Costa Hospital Posadas

Asaf Danon Kamila Olivera Gustavo Costa Hospital Posadas We can see when slow pathways dies. Junctional rhythm is a surrogate of SP damage due to its automaticity cells. With this end-point we do see the end of SP.

Gracias Claudio de Zuloaga y Gustavo Costa por las excelentes disertaciones sobre actualización en arritmias para el cardiólogo clínico, llevadas a cabo en Hospital Posadas. Gs a todos los participantes por acompañar estás iniciativas de capacitación desde Sociedad Argentina de Cardiología.

8 yof patient. Manifest right posterior AP SVT since she was born. s/p unsuccessful prior RFA in other center “Kent potential showed us where to burn” Beautiful ECG depicting ORT termination and first beat of this child without delta wave in her life. Hospital Posadas