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Öğe A wide QRS tachycardia with the short and long ventriculoatrial interval in the presence of an atriofascicular pathway: What is the mechanism?(Wiley, 2022) Özcan Çetin, Elif Hande; Kara, Meryem; Merovci, Idriz; Külekçi, Furkan; Okumuş, Kübra; Sağlam, Onur; Temizhan, Ahmet Yiğit; Korkmaz, Ahmet; Özeke, Özcan; Çay, Serkan; Özcan, Fırat; Aras, Dursun; Topaloğlu, SerkanA 58-year-old man with no structural heart disease presented with recurrent episodes of paroxysmal palpitation. In the electrophysiology laboratory, during the introduction of the venous sheaths and catheters, the patient had spontaneous sustained wide complex tachycardia (WCT) with left bundle branch block (LBBB) morphology. The responses to septal refractory atrial premature complexes (APC) from the lateral right atrium (Figure 1), and ventricular premature complexes (VPC) (Figure 2) were consistent with the atriofascicular (AF) accessory pathway (AP). However, during WCT, a transient atrioventricular (AV) block (Figure 3) with short and long ventriculoatrial (VA) intervals (Figure 4) was also observed. What could be the mechanism of this WCT without 1:1 AV conduction (Figure 3) and change in the VA interval (Figure 4) in a patient with an overt AF pathway?Öğe Convergent double coronary sinus potentials during atrial tachycardia(MediaSphere Medical LLC, 2023) Merovci, Idriz; Yakut, İdris; Gülcü, Oktay; Tunçez, Abdullah; Kara, Meryem; Özcan Çetin, Elif Hande; Korkmaz, Ahmet; Özeke, Özcan; Çay, Serkan; Özcan, Fırat; Aras, Dursun; Topaloğlu, SerkanThe analysis of the patterns and timing of coronary sinus activation provides a rapid stratification of the most likely macro-re-entrant atrial tachycardias and points toward the likely origin of centrifugal ones by comparing the left atrial and coronary sinus activation sequence and morphology during sinus rhythm and atrial tachycardia. The analysis of both the near- and far-field electrogram morphology of atrial signals also gives important clues in determining the mechanism of the arrhythmia.Öğe Dynamic changes in atrial activation sequence during supraventricular tachycardia(Wiley, 2022) Gülcü, Oktay; Merovci, Idriz; Tunçez, Abdullah; Kara, Meryem; Özcan Çetin, Elif Hande; Can, İrem Dilara; Kaplan, Elmas; Korkmaz, Ahmet; Özeke, Özcan; Çay, Serkan; Özcan, Fırat; Aras, Dursun; Topaloğlu, SerkanA29?year?old woman presented with repeated paroxysms ofpalpitations resulting from a rapid narrow QRS complex tachycar-dia (NCT). Her family and personal history were free of anycardiovascular pathology. After the initiation of an NCT following a1:2 ventricular response to programmed atrial stimulation(Figure1), a premature ventricular complex (PVC) from the rightparahisian region was delivered at a time when the His bundleactivation was completed (Figure2); subsequently, a dynamicchange in the retrograde atrial activation sequence (AAS) andventriculoatrial (VA) intervals were developed (Figure3). Based onthe findings within the figures, what is the mechanism of tachycardia?Öğe Multiple wide QRS tachycardias in the same individual with ischemic cardiomyopathy(Wiley, 2023) Özcan Çetin, Elif Hande; Korkmaz, Ahmet; Kara, Meryem; Merovci, Idriz; Göçer, Kemal; Aksu, Ekrem; Abusaif, Suhaib; Oğuz, Ozan; Özeke, Özcan; Çay, Serkan; Özcan, Fırat; Aras, Dursun; Topaloğlu, SerkanA 67 ?year?old diabetic man with ischemic cardiomyopathy presented with a recurrent defibrillator shock. His electrocardiograms showed both narrow (NCT) Figure 1A) and wide complex tachycardias (WCT; Figure 1B). He experienced an anterior myocardial infarction (MI) 11 years earlier that caused the left ventricular ejection fraction to decrease to 25%, and subsequently, a coronary artery bypass surgery was performed and, then implantable cardioverter?defibrillator was implanted for primary prophylaxis 2 years ago. The patient underwent to electrophysiological study for his WCT with a prediagnosis of incessant ventricular tachycardia (VT). In the first stage, the His signals were poor; however, we noticed that the premature ventricular complexes (PVC) reset the subsequent cycle lengths (Figure 2). Since the WCT was right bundle branch block (RBBB) morphology; we applied premature atrial complexes (PAC) with (Figure 3A) and without (Figure3B) septal refractory. Interestingly, we noticed the change in the QRS morphology (Figure 4) and ventriculoatrial (V?A; Figure 5) during ongoing WCT. What are the mechanism of the different QRS morphology and ventriculoatrial (V?A) responses of this tachycardia?Öğe Paradoxical para-hisian pacing response(MediaSphere Medical LLC, 2023) Efe, Tolga Han; Merovci, Idriz; Çalapkuyu, Muhammed Yunus; Özdemir Al, Ceren; Kara, Meryem; Koçyiğit Burunkaya, Duygu; Özcan Çetin, Elif Hande; Korkmaz, Ahmet; Özeke, Özcan; Çay, Serkan; Özcan, Fırat; Aras, Dursun; Topaloğlu, SerkanPara-Hisian pacing (PHP) is among the most useful maneuvers in cardiac electrophysiology during sinus rhythm and identifies whether retrograde conduction is dependent on the atrioventricular (AV) node. In this maneuver, the retrograde activation time and pattern are compared during capture and loss of capture of the His bundle while pacing from a paraHisian position. A common misconception about PHP is that it is useful only for septal accessory pathways (APs). However, even with left or right lateral pathways, as long as pacing from the para-Hisian region conducts to the atrium with the activation sequence being analyzed, it can be used to determine whether that activation is AV node–dependent or AP-dependent.Öğe The roles of pre–P-wave versus peri–P-wave fractionated electrograms for atrial substrate beyond entrainment response(MediaSphere Medical LLC, 2023) Efe, Tolga Han; Merovci, Idriz; Öksüz, Fatih; Eriş, Erdeniz; Kara, Meryem; Koçyiğit Burunkaya, Duygu; Özcan Çetin, Elif Hande; Korkmaz, Ahmet; Özeke, Özcan; Çay, Serkan; Özcan, Fırat; Aras, DursunAtrial tachycardia (AT) with alternating cycle lengths is sparsely reported, and, hence, the ideal mapping strategy has not been firmly established. Beyond the entrainment during tachycardia, some fragmentation characteristics might also give important clues for its possible participation in the macro–re-entrant circuit. We discuss a patient with prior atrial septal defect surgical closures who presented with dual macro–re-entrant ATs related to a fragmented area on the right atrial free wall (240 ms) and the cavotricuspid isthmus (260 ms), respectively. After ablation of the fastest AT on the lateral right atrial free wall, the cycle of the first AT changed to the second AT that was interrupted on cavotricuspid isthmus, proving the dual tachycardia mechanism. This case report addresses the utilization of electroanatomic mapping information as well as fractionated electrogram timing with respect to the surface P-wave as guides for ablation location.Öğe Unusual response to His-synchronous ventricular stimulation during a supraventricular tachycardia: Atrial advancement with or without resetting?(Wiley, 2022) Merovci, Idriz; Gülcü, Oktay; Tunçez, Abdullah; Kara, Meryem; Özcan Çetin, Elif Hande; Yüksekkaya, Baran; Ekici, Ertan; Korkmaz, Ahmet; Özeke, Özcan; Çay, Serkan; Özcan, Fırat; Aras, Dursun; Topaloğlu, SerkanA59?year?old man underwent a diagnostic electrophysiology studybecause of rapid palpitations and documented supraventriculartachycardia (SVT) unresponsive to metoprolol therapy. His 12?leadelectrocardiogram was normal. Baseline atrio?His and His?ventricularintervals measured 48 and 48 ms, respectively. Programmed atrialextrastimulation using single atrial extrastimuli repeatedly induced hisSVT. The response to His refractory ventricular extra stimulations(Hr?VESs) is shown in Figure1. Based on the information, what arethe mechanisms of his tachycardia and apparently discordantresponses?Öğe Widening of the QRS complex during the wide complex tachycardia: What is the mechanism?(Wiley, 2022) Aslan, Ahmet Oğuz; Merovci, Idriz; Tunçez, Abdullah; Öksüz, Fatih; Al, Ertan A.; Kara, Meryem; Özcan Çetin, Elif Hande; Korkmaz, Ahmet; Özeke, Özcan; Çay, Serkan; Özcan, Fırat; Aras, Dursun; Topaloğlu, SerkanA28?year?old woman underwent an electrophysiology study (EPS)because of episodes of palpitations with documented narrow (NCT)and wide QRS complex tachycardia (WCT) on a 24?hHolterECG.During the EPS, the patient was in sinus rhythm (SR) with normalatrio?His (AH) and His?ventricular (HV) intervals of 45 and 55 ms,respectively. The intracardiac electrograms of the tachycardia duringthe spontaneous transition from a WCT with a right bundle branchblock (BBB) morphology (first WCT, f?WCT) to a wider right BBB one(second WCT, s?WCT) are shown in Figure1. Spontaneous conversionbetween the s?WCT and the f?WCT has also been detected during theEPS (Figure2). What is the underlying mechanism?
