Mrs. BW is a 69 year old previously well woman with history of palpitations. Extensive workup showed no evidence of structural heart disease. Her baseline ECG was unremarkable. She was clinically documented to have narrow complex tachycardia. In tachycardia her ECG showed brief bursts of ectopic atrial activity with “saw-tooth” appearance in the inferior leads (Figure 1, Panel A) alternating with lesser amplitude p-waves positive in the inferior leads and in V1 (Figure 1, Panel B). During electrophysiology study a quadripolar catheter was placed at the right ventricular apex, a decapolar catheter in the coronary sinus, a duodecapolar catheter around the tricuspid annulus and a quadripolar catheter at the His bundle position.
Credits: Yaariv Khaykin MD; Zaev Wulffhart MD; Bonnie Whaley CCT; Atul Verma MD