Sorry for late reply, looks like that one was not cor triatriatum, it was a Big Giant Pulmonary Artery with Dissection Flap

Interesting ECG, it seems the P-P Interval Is Constant

Other R-R Interval Seems Constant Beside R4-R5

IMO there is a change conduction into slow pathway, from the Red pathway P Arrow to Blue pathway P Arrow

😨, great case.. thanks for sharing 🙏

Pretty impressive, no?

#echosky #cardiosky

I agree looks like VSP, perhaps there is atrial spike within the R1 (Possibly Atrial Lead Did not Sensed the P Before R1 and Pace As the Moment of Native R wave and Trigger VSP)

I think purple arrow is really correlated with pace spike.. is that spesial ECG feature for detecting pacemaker spike?

Carcinoid Syndrome?

I vote for VT as well

Presence of Structural Heart Disease, Atypical RBBB with R<S at V5 and V6, Same PVC Morphology in 2nd ECG Favors for VT

The Location of VT IMO is Mid Inferolateral LV, maybe correlated with mid lateral scar at MRI

Another Echo View A5C

Another Echo View PSAX

Another Echo View Suprasternal Right Aortic Arch

Here Is The CT Scan, Any Opinion About Diagnosis Terminology? And How Should We Manage? #Cardiosky #Echosky #Echofirst #YesCCT #CTSky

Parahisian

I think This Red P Wave Is Conducted because repetitive same PR Interval Manners

Other QRS are Junctional Escape Beat

2nd ECG, I think atrial lead is also not sensing at all, it seems capture

But i suspecting the black arrow the atrial lead is pacing but failed to make a spike (Fail to Pace)

Somehow A. Lead Alternating Capture and Failed to Pace

Atrial Lead Problem (Fracture or Insulation Breach)?

CMIIW 🙏

Amazing Tracing, May I give my opinion doctor? Please correct me if i'm wrong

Below ECG, I Think This is Atrial Lead Undersensing and Does not Capture

Blue Arrow => Intrinsic P Wave
Green Arrow => P Wave That Conduct to Ventricle
Red Arrow => VSP due to sensing intrinsic beat After AP

I'm not the expert, but i like to push my brain figure out tracing like this

I don't see any atrial pacing on 2nd follow up ECG, i suspect that was AF and modeswitch to DDI pacing.

So i suspect the 1st ecg was AF undersensing, but i think we need to confirm presence of CHB to support my opinion