A clinical approach to arrhythmias revisited in 2018

Figures

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  Fig. 1. The original concept of Coumel on the left (a), and its generally well-known final form (b), as the triangle of Coumel, explaining how the interaction of substrate, triggers and the autonomic nervous system are important in arrhythmogenesis. (Modified after [2])

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  Fig. 2. Holter recording of a professional cyclist with symptomatic atrial fibrillation and dizziness. a Bradycardia at rest, with a short episode of slow conduction of atrial flutter or fibrillation. b During exercise atrial flutter, with suddenly 1:1 conduction. c Continuation of b, with slowing of the atrioventricular conduction at the end

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  Fig. 3. Drug study of a marathon runner with syncope. The 6th complex shows a ventricular extrasystole, negative in lead I, and positive in the inferior leads. The transition is very early, indicating a left ventricular origin. After isuprel infusion, a fast sustained tachycardia occurs, initiated by a similar left ventricular complex, while the VT suggests a right ventricular outflow tract origin

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  Fig. 4. Coexistent ventricular tachycardia (VT) in a patient with arrhythmogenic right ventricular cardiomyopathy (ARVC), and ventricular extrasystoles (VPB) originating in the right ventricular outflow tract (RVOT)