case_images: PMC4119906_01
case_images: (a) Regular sinus rhythm at 70 beats per minute, a wide QRS and PR interval was 120 ms (b) post ablation we show a normal QRS.
case_images: CRIM2014-789537.001.jpg
case_images: PMC4119906_01_CRIM2014-789537.001.jpg
case_images: fig1
case_images: The ECG showed a regular sinus rhythm at 70 beats per minute, a complete right branch block, and posterior left hemiblock (Figure 1), and PR interval was 120 ms.
case_images: In atrial pacing, effective accessory pathway refractory period was 290 ms effective ((a) and (b)). The QRS had the same morphology during atrial pacing (c).
case_images: CRIM2014-789537.002.jpg
case_images: PMC4119906_01_CRIM2014-789537.002.jpg
case_images: fig2
case_images: Programmed atrial stimulation was performed in the basal state and showed an effective atrial refractory period of right atrium at 200 ms and effective refractory period of accessory tract was 300 ms (Figure 2).
case_images: The electrophysiology study showed a shorter AV at the distal electrode of decapolar (a) with dissociation atrioventricular conduction in retrograde (b). This figure confirmed the diagnosis of a left accessory bypass with only anterograde conduction.
case_images: CRIM2014-789537.003.jpg
case_images: PMC4119906_01_CRIM2014-789537.003.jpg
case_images: fig3
case_images: We inserted a catheter of exploration in coronary sinus; we recorded a shorter AV at the distal electrode of decapolar that confirmed the diagnosis of a left accessory bypass (Figure 3).
case_images: ECG after using isuprel: the use of isuprel showed the classic figure of Wolff-Parkinson-White syndrome with a typical QRS with slurred initial QRS.
case_images: CRIM2014-789537.004.jpg
case_images: PMC4119906_01_CRIM2014-789537.004.jpg
case_images: fig4
case_images: AV node (Figure 4). AH interval with isuprel was 100 ms and HV interval was 42 ms.
case_images: After the use of isuprel ((b) HV was 42 ms), HV interval was longer than the basal state ((a) HV was -24 ms). The isuprel accelerated atrioventricular conduction.
case_images: CRIM2014-789537.005.jpg
case_images: PMC4119906_01_CRIM2014-789537.005.jpg
case_images: fig5
case_images: This was explicated by an accelerated atrioventricular conduction with isuprel in addition to accessory pathway (Figure 5).
case_images: In atrial pacing, effective accessory pathway refractory period was 290 ms effective ((a) and (b)). The QRS had the same morphology during atrial pacing.
case_images: CRIM2014-789537.006.jpg
case_images: PMC4119906_01_CRIM2014-789537.006.jpg
case_images: fig6
case_images: The effective refractory period of accessory pathway was 210 ms with isuprel (Figure 6).
case_images: (a) Electrophysiology signal before the ablation. (b) The distal coronary sinus signal showed a separated ventricular signal from atria signal during ablation. The successful left accessory bypass ablation persisted.
case_images: CRIM2014-789537.007.jpg
case_images: PMC4119906_01_CRIM2014-789537.007.jpg
case_images: fig7
case_images: Thus, we had decided to ablate the accessory pathway (Figure 7).