4:2:1 conduction of an AF initiating trigger

Pipin Kojodjojo; Eric Chong; Toon Wei Lim; Swee Chong Seow

doi:10.1016/j.ipej.2015.11.004

4:2:1 conduction of an AF initiating trigger

Indian Pacing Electrophysiol J. 2015 Nov 18;15(5):255-8. doi: 10.1016/j.ipej.2015.11.004. eCollection 2015 Sep-Oct.

Authors

Pipin Kojodjojo¹, Eric Chong¹, Toon Wei Lim¹, Swee Chong Seow¹

Affiliation

¹ National University Heart Centre, National University Hospital, 1E Kent Ridge Road, NUHS Tower Block, Level 9, 119228, Singapore.

Abstract

A 44 year old male with idiopathic dilated cardiomyopathy was undergoing persistent atrial fibrillation (AF) ablation. Following antral ablation, AF terminated into a regular narrow complex rhythm. Earliest activation was mapped to a focus in the superior vena cava (SVC) which was conducted in a 2:1 ratio to the atria which in turn was conducted with 2:1 ratio to the ventricles, resulting in an unusual 4:2:1 conduction of the SVC tachycardia. 1:1 conduction of the SVC tachycardia to the atrium preceded initiation of AF. During AF, SVC tachycardia continued unperturbed. Sinus rhythm was restored following catheter ablation of the focus.

Keywords: Ablation; Atrial fibrillation; Superior vena cava tachycardia.