Coumel's sign reversed: What is the mechanism?

Dinakar Bootla; Ashish Jain; Gaurav Kumar Mittal; Raja J Selvaraj

doi:10.1016/j.ipej.2021.11.007

Coumel's sign reversed: What is the mechanism?

Indian Pacing Electrophysiol J. 2022 Mar-Apr;22(2):115-117. doi: 10.1016/j.ipej.2021.11.007. Epub 2021 Nov 24.

Authors

Dinakar Bootla¹, Ashish Jain², Gaurav Kumar Mittal², Raja J Selvaraj²

Affiliations

¹ Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India. Electronic address: dinakarhere@gmail.com.
² Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.

Abstract

A patient presented with documented narrow QRS tachycardia. During electrophysiological study, he has orthodromic reciprocating tachycardia with atrial activation consistent with left free wall accessory pathway. With induction of tachycardia, beats with LBBB morphology have shorter cycle length than those with narrow QRS. What is the mechanism?

Keywords: CL increase with narrow QRS; Dual AV nodal Physiology; Reverse Coumel.