BURNING NEAR THE HIS BUNDLEk-hrs.org/KHRS/2018/pdf/35. Imran Khan.pdf · 2018-06-23 · BURNING...
Transcript of BURNING NEAR THE HIS BUNDLEk-hrs.org/KHRS/2018/pdf/35. Imran Khan.pdf · 2018-06-23 · BURNING...
![Page 1: BURNING NEAR THE HIS BUNDLEk-hrs.org/KHRS/2018/pdf/35. Imran Khan.pdf · 2018-06-23 · BURNING NEAR THE HIS BUNDLE Presented by Dr.Imran Khan EP and Pacing Division Cardiology Department](https://reader035.fdocuments.in/reader035/viewer/2022081406/5f13eab50118ea06387c72b6/html5/thumbnails/1.jpg)
BURNING NEAR THE HIS BUNDLE
Presented by
Dr.Imran Khan
EP and Pacing Division
Cardiology Department
Hayat Abad Medical Complex Peshawar
Pakistan
![Page 2: BURNING NEAR THE HIS BUNDLEk-hrs.org/KHRS/2018/pdf/35. Imran Khan.pdf · 2018-06-23 · BURNING NEAR THE HIS BUNDLE Presented by Dr.Imran Khan EP and Pacing Division Cardiology Department](https://reader035.fdocuments.in/reader035/viewer/2022081406/5f13eab50118ea06387c72b6/html5/thumbnails/2.jpg)
CASE HISTORYA 35 years old male with history of recurrent
palpitation…..2 years.
• No h/o dyspnea and fatigue.
• No history of Syncope and pre Syncope.
• No comorbidities.No F/Hx of SCD.
• Medical Hx: Bisoprolol 10mg OD x 2 years
• Amiodarone 100mg OD x 1 year.
• ECHO: LV: 5.6 ,EF:46%
• 24 hours Holter ECG: PVCs burden 23%(26k)
![Page 3: BURNING NEAR THE HIS BUNDLEk-hrs.org/KHRS/2018/pdf/35. Imran Khan.pdf · 2018-06-23 · BURNING NEAR THE HIS BUNDLE Presented by Dr.Imran Khan EP and Pacing Division Cardiology Department](https://reader035.fdocuments.in/reader035/viewer/2022081406/5f13eab50118ea06387c72b6/html5/thumbnails/3.jpg)
ECG
![Page 4: BURNING NEAR THE HIS BUNDLEk-hrs.org/KHRS/2018/pdf/35. Imran Khan.pdf · 2018-06-23 · BURNING NEAR THE HIS BUNDLE Presented by Dr.Imran Khan EP and Pacing Division Cardiology Department](https://reader035.fdocuments.in/reader035/viewer/2022081406/5f13eab50118ea06387c72b6/html5/thumbnails/4.jpg)
![Page 5: BURNING NEAR THE HIS BUNDLEk-hrs.org/KHRS/2018/pdf/35. Imran Khan.pdf · 2018-06-23 · BURNING NEAR THE HIS BUNDLE Presented by Dr.Imran Khan EP and Pacing Division Cardiology Department](https://reader035.fdocuments.in/reader035/viewer/2022081406/5f13eab50118ea06387c72b6/html5/thumbnails/5.jpg)
INTRACARDIAC TRACINGS
![Page 6: BURNING NEAR THE HIS BUNDLEk-hrs.org/KHRS/2018/pdf/35. Imran Khan.pdf · 2018-06-23 · BURNING NEAR THE HIS BUNDLE Presented by Dr.Imran Khan EP and Pacing Division Cardiology Department](https://reader035.fdocuments.in/reader035/viewer/2022081406/5f13eab50118ea06387c72b6/html5/thumbnails/6.jpg)
![Page 7: BURNING NEAR THE HIS BUNDLEk-hrs.org/KHRS/2018/pdf/35. Imran Khan.pdf · 2018-06-23 · BURNING NEAR THE HIS BUNDLE Presented by Dr.Imran Khan EP and Pacing Division Cardiology Department](https://reader035.fdocuments.in/reader035/viewer/2022081406/5f13eab50118ea06387c72b6/html5/thumbnails/7.jpg)
RADIOSCOPIC
LOCALIZATION
![Page 8: BURNING NEAR THE HIS BUNDLEk-hrs.org/KHRS/2018/pdf/35. Imran Khan.pdf · 2018-06-23 · BURNING NEAR THE HIS BUNDLE Presented by Dr.Imran Khan EP and Pacing Division Cardiology Department](https://reader035.fdocuments.in/reader035/viewer/2022081406/5f13eab50118ea06387c72b6/html5/thumbnails/8.jpg)
Abl
His
![Page 9: BURNING NEAR THE HIS BUNDLEk-hrs.org/KHRS/2018/pdf/35. Imran Khan.pdf · 2018-06-23 · BURNING NEAR THE HIS BUNDLE Presented by Dr.Imran Khan EP and Pacing Division Cardiology Department](https://reader035.fdocuments.in/reader035/viewer/2022081406/5f13eab50118ea06387c72b6/html5/thumbnails/9.jpg)
Abl
His
![Page 10: BURNING NEAR THE HIS BUNDLEk-hrs.org/KHRS/2018/pdf/35. Imran Khan.pdf · 2018-06-23 · BURNING NEAR THE HIS BUNDLE Presented by Dr.Imran Khan EP and Pacing Division Cardiology Department](https://reader035.fdocuments.in/reader035/viewer/2022081406/5f13eab50118ea06387c72b6/html5/thumbnails/10.jpg)
His
Abl
![Page 11: BURNING NEAR THE HIS BUNDLEk-hrs.org/KHRS/2018/pdf/35. Imran Khan.pdf · 2018-06-23 · BURNING NEAR THE HIS BUNDLE Presented by Dr.Imran Khan EP and Pacing Division Cardiology Department](https://reader035.fdocuments.in/reader035/viewer/2022081406/5f13eab50118ea06387c72b6/html5/thumbnails/11.jpg)
3D LAT MAPPING
![Page 12: BURNING NEAR THE HIS BUNDLEk-hrs.org/KHRS/2018/pdf/35. Imran Khan.pdf · 2018-06-23 · BURNING NEAR THE HIS BUNDLE Presented by Dr.Imran Khan EP and Pacing Division Cardiology Department](https://reader035.fdocuments.in/reader035/viewer/2022081406/5f13eab50118ea06387c72b6/html5/thumbnails/12.jpg)
![Page 13: BURNING NEAR THE HIS BUNDLEk-hrs.org/KHRS/2018/pdf/35. Imran Khan.pdf · 2018-06-23 · BURNING NEAR THE HIS BUNDLE Presented by Dr.Imran Khan EP and Pacing Division Cardiology Department](https://reader035.fdocuments.in/reader035/viewer/2022081406/5f13eab50118ea06387c72b6/html5/thumbnails/13.jpg)
![Page 14: BURNING NEAR THE HIS BUNDLEk-hrs.org/KHRS/2018/pdf/35. Imran Khan.pdf · 2018-06-23 · BURNING NEAR THE HIS BUNDLE Presented by Dr.Imran Khan EP and Pacing Division Cardiology Department](https://reader035.fdocuments.in/reader035/viewer/2022081406/5f13eab50118ea06387c72b6/html5/thumbnails/14.jpg)
![Page 15: BURNING NEAR THE HIS BUNDLEk-hrs.org/KHRS/2018/pdf/35. Imran Khan.pdf · 2018-06-23 · BURNING NEAR THE HIS BUNDLE Presented by Dr.Imran Khan EP and Pacing Division Cardiology Department](https://reader035.fdocuments.in/reader035/viewer/2022081406/5f13eab50118ea06387c72b6/html5/thumbnails/15.jpg)
![Page 16: BURNING NEAR THE HIS BUNDLEk-hrs.org/KHRS/2018/pdf/35. Imran Khan.pdf · 2018-06-23 · BURNING NEAR THE HIS BUNDLE Presented by Dr.Imran Khan EP and Pacing Division Cardiology Department](https://reader035.fdocuments.in/reader035/viewer/2022081406/5f13eab50118ea06387c72b6/html5/thumbnails/16.jpg)
![Page 17: BURNING NEAR THE HIS BUNDLEk-hrs.org/KHRS/2018/pdf/35. Imran Khan.pdf · 2018-06-23 · BURNING NEAR THE HIS BUNDLE Presented by Dr.Imran Khan EP and Pacing Division Cardiology Department](https://reader035.fdocuments.in/reader035/viewer/2022081406/5f13eab50118ea06387c72b6/html5/thumbnails/17.jpg)
![Page 18: BURNING NEAR THE HIS BUNDLEk-hrs.org/KHRS/2018/pdf/35. Imran Khan.pdf · 2018-06-23 · BURNING NEAR THE HIS BUNDLE Presented by Dr.Imran Khan EP and Pacing Division Cardiology Department](https://reader035.fdocuments.in/reader035/viewer/2022081406/5f13eab50118ea06387c72b6/html5/thumbnails/18.jpg)
![Page 19: BURNING NEAR THE HIS BUNDLEk-hrs.org/KHRS/2018/pdf/35. Imran Khan.pdf · 2018-06-23 · BURNING NEAR THE HIS BUNDLE Presented by Dr.Imran Khan EP and Pacing Division Cardiology Department](https://reader035.fdocuments.in/reader035/viewer/2022081406/5f13eab50118ea06387c72b6/html5/thumbnails/19.jpg)
POST ABLATION ECG
![Page 20: BURNING NEAR THE HIS BUNDLEk-hrs.org/KHRS/2018/pdf/35. Imran Khan.pdf · 2018-06-23 · BURNING NEAR THE HIS BUNDLE Presented by Dr.Imran Khan EP and Pacing Division Cardiology Department](https://reader035.fdocuments.in/reader035/viewer/2022081406/5f13eab50118ea06387c72b6/html5/thumbnails/20.jpg)
![Page 21: BURNING NEAR THE HIS BUNDLEk-hrs.org/KHRS/2018/pdf/35. Imran Khan.pdf · 2018-06-23 · BURNING NEAR THE HIS BUNDLE Presented by Dr.Imran Khan EP and Pacing Division Cardiology Department](https://reader035.fdocuments.in/reader035/viewer/2022081406/5f13eab50118ea06387c72b6/html5/thumbnails/21.jpg)
CONCLUSION
•A Parahisian origin is suggested by particular electrocardiographic
characteristics and early activation at the His catheter.
• A successful ablation strategy is based on a detailed activation mapping
of the right and left Parahisian regions from adjacent structures, including
the right and left septal ventricles, the aortic sinuses, and the inferomedial
RA.
•In conclusion, we performed a successful catheter ablation of a PVC
from the para Hisian region under activation mapping guidance.
•Detailed mapping and careful delivery of RF energy are essential for
successful ablation without AV block creation.
![Page 22: BURNING NEAR THE HIS BUNDLEk-hrs.org/KHRS/2018/pdf/35. Imran Khan.pdf · 2018-06-23 · BURNING NEAR THE HIS BUNDLE Presented by Dr.Imran Khan EP and Pacing Division Cardiology Department](https://reader035.fdocuments.in/reader035/viewer/2022081406/5f13eab50118ea06387c72b6/html5/thumbnails/22.jpg)
THANK YOU