Tachycardia with Left Bundle Branch Block Morphology in a Patient with Right Bundle Branch Block

Figures

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  Fig. 1. Tracing from Holter recording at the time when the patient was asleep at 05.50:36 a.m,

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  Fig. 2. Tracing from Holter recording at the time when the patient was awake at 13:14:36 p.m, and felt her clinical palpitations.

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  Fig. 3. Explanation of tracing in Figure 1. See text.

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  Fig. 4. Explanation of tracing in Figure 2. See text.

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  Fig. 5. Left panel: Electrophysiologic recordings during antidromic tachycardia at the site of successful ablation of the AP. Shown is the LBBB complex resulting from the antegrade activation over the right posteroseptal AP followed by retrograde atrial activity over the AV node. Note the QS pattern during unipolar recording and the 25 ms early ventricular activation as compared to QRS onset. Also note the recordings of both the ventricular and atrial electrograms suggesting that the catheter is placed at an annular area. Right panel: 3D Carto activation mapping in left anterior oblique position during antidromic tachycardia. The ablation catheter is positioned at the earliest antegrade ventricular activation in the posteroseptal region of the tricuspid annulus. Activation is 25 ms earlier than the QRS. The pink balls represent ablation application sites. The yellow ball annotates the His region. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)