Fig 2 - uploaded by Josep Brugada
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a. The 12-lead ECG of the tachycardia with 2:1 conduction block to the ventricle. b. Lead V1 with a pseudo R-wave visible at the terminal portion of the QRS and the second P wave right after the T
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... S2 decrease was continued and when it reached 210 ms, clinical tachycardia was induced with a cycle length of 250 ms, an AV ratio of 1 to 1, HA and AH conduction interval of 215 ms, and AH/HA ratio > 1, which was consistent with typical AVNRT (slow-fast) 2 ; it should be noted that atrial and ventricular activation was simultaneous (Fig. 2). Subsequently, and spontaneously, the tachycardia showed a two-to-one AV ratio, due to a supra-Hisian block; thanks to this phenomenon, it was possible to better observe the P waves, which were positive in V1, some produced pseudo-R in V1 and others were in the descending portion of the T wave, simulating the morphology of lips (Fig. 3) 3 . The tachycardia was terminated with overstimulation, and ablation of the slow nodal pathway was performed, with the procedure being successful and without complications. ...
... Se continuó con el descenso del S2 y cuando este llegó a 210 ms se logró inducir la taquicardia clínica con Longitud de ciclo (LC) de 250 ms, relación AV 1 a 1, intervalo de conducción HA y AH 215 ms y cociente AH/HA > 1, compatible con TRNAV típica (lenta-rápida) 2 ; cabe señalar que la activación auricular y ventricular eran simultáneas (Fig. 2). Posteriormente y de manera espontánea la taquicardia presentó una relación AV dos a uno, debido a un bloqueo suprahisiano; gracias a este fenómeno se pudo apreciar mejor las ondas P, las cuales eran positivas en V1, unas producían pseudo R en V1 y otras se encontraban en la parte descendente de la onda T, simulando la morfología de unos labios (Fig. 3) 3 . La taquicardia se terminó con sobreestimulación y se realizó ablación de la vía nodal lenta, siendo el procedimiento exitoso y sin complicaciones. ...
