2/7 13yo girl, hospital admission with palpitations. 24-h ECG Monitoring reveals episodes of tachycardia with on-off phenomen and HR up to 120 bpm.
Next Step➡️EP diagnostic
3/7 EP study reveals 2 tachys : AT1 with CL 590ms, AT2 with CL 380ms. Note the same CS activation sequence.
Next Step➡️RA mapping
4/7 RA map of both tachys: earliest activation – SVC ( most likely farfield from RSPV)
Next Step➡️ transseptal puncture and LA mapping
5/7 LA mapping reveals the focal atrial tachycardia from LIPV.
6/7 Isolation of LPVs
7/7 No recurrence of tachy in 24-h ECG monitoring. No complaints.
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2/8 1⃣VA=110 ms(> 85 ms)➡️AVRT or atypical AVNRT or AT with unusually long AV conduction
2⃣Termintion of tachycardia
✅Termination with AV➡️AT or AVNRT or AVRT