ECG and Arrhythmias PDF

Clinical EP Studies Lab Ravi Ranjan MD PhD Division of Cardiovascular Medicine [email protected]  Normal ECG JANSSON, ERICK ID:008847097 17-OCT-2011 12:08:15...

Clinical EP Studies Lab Ravi Ranjan MD PhD Division of Cardiovascular Medicine [email protected]  Normal ECG JANSSON, ERICK ID:008847097 17-OCT-2011 12:08:15 UNIVERSITY HEALTH CARE 16-JUN-1947 (64 yr) Vent. rate 62 BPM Normal sinus rhythm Male Caucasian PR interval 154 ms Normal ECG QRS duration 92 ms No previous ECGs available Room: QT/QTc 402/408 ms Loc:126 P-R-T axes 36 38 40 Technician: AMBER Test ind:780.2 Referred by: MOHAMED HAMDAN Confirmed By: Ravi Ranjan I aVR V1 V4 II aVL V2 V5 III aVF V3 V6 V1 II V5 25mm/s 10mm/mV 150Hz 7.1.1 12SL 239 CID: 51 EID:3216 EDT: 15:54 27-OCT-2011 ORDER: Page 1 of 1 STEMI STEMI Heart Block 2:1 Heart Block  LBBB EASTER, JACK ID:001513741 25-OCT-2011 13:51:50 UNIVERSITY HEALTH CARE 77 yr Vent. rate 64 BPM Sinus rhythm with 1st degree A-V block Male PR interval 234 ms Left axis deviation QRS duration 184 ms Left bundle branch block Room:02 QT/QTc 516/532 ms Abnormal ECG Loc:4 Option:1 P-R-T axes -23 -57 117 No previous ECGs available Technician: TSS Test ind:VT Referred by: HAMDAN Confirmed By: Ravi Ranjan Comment:185310459 Study: I aVR V1 V4 II aVL V2 V5 III aVF V3 V6 V1 II V5 25mm/s 10mm/mV 150Hz 7.1.1 12SL 239 CID: 70 EID:3216 EDT: 16:43 27-OCT-2011 ORDER: Page 1 of 1  RBBB GODFREY, JEFFREY ID:011951696 25-OCT-2011 08:12:43 UNIVERSITY HEALTH CARE 17-JAN-1952 (59 yr) Vent. rate 53 BPM Sinus bradycardia Male Caucasian PR interval 174 ms Right bundle branch block 75in 182lb QRS duration 138 ms Abnormal ECG Room:06 QT/QTc 458/429 ms When compared with ECG of 30-SEP-2011 09:46, Loc:4 Option:0 P-R-T axes 76 78 46 No significant change was found Technician: TSS Test ind:786.50 Referred by: BRENT WILSON Confirmed By: Ravi Ranjan COMMENT:186843227 I aVR V1 V4 II aVL V2 V5 III aVF V3 V6 V1 II V5 25mm/s 10mm/mV 150Hz 7.1.1 12SL 235 CID: 49 EID:3216 EDT: 16:10 27-OCT-2011 ORDER: ACCOUNT: 186843227 Page 1 of 1  Supra Ventricular Tachycardia WILSON, MAGGIE Patient ID:006527154 196 bpm RECOVERY Bruce U of U 10/14/2011 0.0 mph 5:08:46pm 00:30 0.0 % I aVR V1 V4 II aVL V2 V5 III aVF V3 V6 GE Medical Systems IT CASE V5.02 25mm/s 10mm/mV 60Hz 0.01-40Hz S+ HR(V1,V2)  Supra Ventricular Tachycardia (SVT) AVNRT – AV nodal re-entrent tachycardia AVRT – Atrio-ventricular re-entrent tachycardia AT – atrial tachycardia  SVT initiation AVNRT ORT AV nodal re-entrent Orthodromic re-entrent AT tachycardia tachycardia Atrial Tachycardia Dual Node Pathway AVNRT Basic EP recordings Basic EP recordings Dual Node Pathway AVNRT  WPW WILSON, TRISHA ID:020337763 26-JUL-2011 07:38:35 UNIVERSITY HEALTH CARE 28-JAN-1988 (23 yr) Vent. rate 56 BPM Sinus bradycardia with evidence of pre-excitation (WPW) Female PR interval 80 ms Abnormal ECG QRS duration 164 ms No previous ECGs available Room:01 QT/QTc 470/453 ms Loc:4 Option:0 P-R-T axes 106 41 45 Technician: TSS Test ind:426.7 Referred by: Roger FREEDMAN Confirmed By: Mohamed HAMDAN Comment:186170738 Study: I aVR V1 V4 II aVL V2 V5 III aVF V3 V6 V1 II V5 25mm/s 10mm/mV 150Hz 7.1.1 12SL 239 CID: 70 EID:111 EDT: 08:30 18-OCT-2011 ORDER: ACCOUNT: 186170738 Page 1 of 1 WILSON, TRISHA 28-JAN-1988 (23 yr) Female Vent. rate PR interval ID:020337763 56 80 BPM ms WPW 26-JUL-2011 07:38:35 Sinus bradycardia with evidence of pre-excitation (WPW) Abnormal ECG UNIVERSITY HEALTH CARE QRS duration 164 ms No previous ECGs available Room:01 QT/QTc 470/453 ms Loc:4 Option:0 P-R-T axes 106 41 45 Technician: TSS Test ind:426.7 Referred by: Roger FREEDMAN Confirmed By: Mohamed HAMDAN Comment:186170738 Study: I aVR V1 V4 II aVL V2 V5 III aVF V3 V6 V1 II V5 25mm/s 10mm/mV 150Hz 7.1.1 12SL 239 CID: 70 EID:111 EDT: 08:30 18-OCT-2011 ORDER: ACCOUNT: 186170738 Page 1 of 1  AVRT – initiation Orthodromic Re-entrent Tachycardia (ORT) ORT Atrial Tachycardia (AT)  SVT initiation AVNRT ORT AV nodal re-entrent Orthodromic re-entrent AT tachycardia tachycardia Atrial Tachycardia  Parahisian Pacing No AP With AP Retrograde Atrial Activation Concentric vs Eccentric Retrograde Atrial Activation Concentric vs Eccentric Location of Accessory Pathway Effect of BBB in SVT With LBBB the VA time increases Left sided pathway and RBBB Left sided pathway and RBBB No change in VA PVC on His PVC on His Case Study  74 year old female with a long standing history of palpitations since 1999 More frequent over the last one year In the past, episodes were resolved with Valsalva but now they are not terminated with Valsalva Labs, Echo normal  Normal ECG JANSSON, ERICK ID:008847097 17-OCT-2011 12:08:15 UNIVERSITY HEALTH CARE 16-JUN-1947 (64 yr) Vent. rate 62 BPM Normal sinus rhythm Male Caucasian PR interval 154 ms Normal ECG QRS duration 92 ms No previous ECGs available Room: QT/QTc 402/408 ms Loc:126 P-R-T axes 36 38 40 Technician: AMBER Test ind:780.2 Referred by: MOHAMED HAMDAN Confirmed By: Ravi Ranjan I aVR V1 V4 II aVL V2 V5 III aVF V3 V6 V1 II V5 25mm/s 10mm/mV 150Hz 7.1.1 12SL 239 CID: 51 EID:3216 EDT: 15:54 27-OCT-2011 ORDER: Page 1 of 1 Baseline 6 yo with SVT Baseline 12 lead Baseline EGMs V stim Tachycardia Initiation SVT EGMs SVT 12 Lead Pacing during SVT Pacing during SVT PPI - TCL PVC timed with His PVC timed with His PVC timed with His Para-hisian Pacing Para-hisian Pacing Ablation site Ablation Post Ablation – VA block with adenosine 24 year old with palpitations for many years EKG Baseline 12 Lead Baseline EGMs A1A1 300 msec S1S1 300 SVT initiation SVT Self termination Para-hisian VA Retrograde mapping Ablation Post Ablation Post Ablation