Elctrophysiology Presentation: Coumel Law. pptx

.

1. Coumel Phenomenon Amit Gulati, MD

2. Philippe Coumel

3. A 51-year-old man was admitted to the hospital with palpitation that had been occurring for 3 years. He described each episode as presenting with sudden onset and termination that lasted for several minutes and alleviated spontaneously. His admission echocardiography was normal. ECG indicated supraventricular tachycardia with complete left bundle-branch block (LBBB). He received intravenous verapamil. Based on the ECG, what is the mechanism of tachycardia?

4. Prolongation of cycle length of ORT during ipsilateral bundle branch block is due to prolongation of the VA interval.

5. Most common cause of absence of change in CL or change in CL less than expected is an increase in AH interval due to decremental atrioventricular nodal conduction when the VA interval decreases during the narrow QRS tachycardia. The significantly longer AH is consistent with change in antegrade conduction from a fast pathway to a slow pathway. 

6. Thank You