Hypothesis testing as an approach to the analysis of complex tachycardias--an illustrative case of a preexcitation variant.
The correct elucidation of the electrophysiological substrate and mechanism(s) responsible for a complex arrhythmia requires a systematic approach to the analysis of the electrophysiological data. One approach calls for the formulation of a set of hypotheses that could explain the data obtained during the study. The hypotheses are then tested for compatibility with phenomena observed and the one that agrees with the majority of the findings would represent the most tenable explanation. We present the case of a young girl with a wide QRS complex tachycardia and a history of ventricular preexcitation that illustrates this approach. The complexities were resolved only after intraoperative analysis and surgical ablation of a right-sided accessory pathway with decremental properties, and provides further insight into our understanding of the nodoventricular Mahaim fiber.
Teo
W S
WS
Department of Medicine, University Hospital, London, Ontario, Canada.
Yee
R
R
Klein
G J
GJ
Guiraudon
G M
GM
Leitch
J W
JW
D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D002304:Cardiac Pacing, Artificial; D002648:Child; D004562:Electrocardiography; D004564:Electrocoagulation; D004594:Electrophysiology; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D011226:Pre-Excitation Syndromes / Q000175:diagnosis; D011227:Pre-Excitation, Mahaim-Type / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D013617:Tachycardia, Supraventricular / Q000503:physiopathology
D000889:Anti-Arrhythmia Agents