Alternating wide complex tachycardia after surgical aortic valve replacement

Figures

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  Fig. 1. A. Presenting ECG: WCT with RBBB morphology. B. Post-cardioversion: NSR, prolonged PR interval, and incomplete RBBB. C. Post-SAVR: WCT with LBBB morphology. D. Day of discharge after SAVR: NSR, prolonged PR interval with RBBB morphology.

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  Fig. 2. A. 12-lead ECG of WCT induced during EPS. LBBB-type morphology with negative concordance in the precordial leads and left superior axis. B. Consistent His bundle potential was not obtained. RB potential (as measured on Abl-D) to V interval during sinus rhythm measures 42 ms, while the RB-V is longer during tachycardia (78 ms). C. Changes in the RB-RB interval precedes the changes in the V–V interval.

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  Fig. 3. Schematic representation of BBRVT. A.) During LBBB-BBRVT, the impulse is conducted anterogradely through the RBB and retrogradely through the LBB. B.) During RBBB-BRVT, the activation pattern is reversed. Note the His is activated retrogradely and not involved in the BBRVT circuit.