Sudden QRS morphology change during ventricular pacing in a scar-related isthmus What is the mechanism?

Philippe Maury; Anne Rollin; Jean-Marc Sellal; Alexandre Duparc; Pierre Mondoly; Christelle Cardin; Christian De Chillou

doi:10.1016/j.jelectrocard.2016.07.035

Sudden QRS morphology change during ventricular pacing in a scar-related isthmus What is the mechanism?

J Electrocardiol. 2016 Nov-Dec;49(6):973-976. doi: 10.1016/j.jelectrocard.2016.07.035. Epub 2016 Aug 4.

Authors

Philippe Maury¹, Anne Rollin², Jean-Marc Sellal³, Alexandre Duparc², Pierre Mondoly², Christelle Cardin², Christian De Chillou³

Affiliations

¹ University Hospital Rangueil Toulouse, France. Electronic address: mauryjphil@hotmail.com.
² University Hospital Rangueil Toulouse, France.
³ University Hospital Nancy, France.

PMID: 27567390
DOI: 10.1016/j.jelectrocard.2016.07.035

Abstract

We present an example of sudden modification in QRS morphology during ventricular pacing inside a scar-related isthmus. This is explained by a "concealed" sudden block in both the orthodromic and antidromic wavefront directions, allowing then the activation to proceed through a now overt antidromic conduction.

Keywords: Entrainment; Isthmus; Pace-mapping; Reentry circuit; Ventricular tachycardia.

Publication types

Case Reports

MeSH terms

Aged
Cardiac Resynchronization Therapy / methods*
Cicatrix / complications
Cicatrix / diagnosis*
Diagnosis, Differential
Electrocardiography / methods*
Female
Humans
Myocardial Stunning / complications
Myocardial Stunning / diagnosis*
Tachycardia, Ventricular / diagnosis*
Tachycardia, Ventricular / etiology
Tachycardia, Ventricular / surgery
Treatment Outcome