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

Coumel's sign reversed: What is the mechanism?

Dinakar Bootla  1 , Ashish Jain  2 , Gaurav Kumar Mittal  2 , Raja J Selvaraj  2
Affiliations

Coumel's sign reversed: What is the mechanism?

Dinakar Bootla et al. Indian Pacing Electrophysiol J. 2022 Mar-Apr.

Erratum in

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.

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Conflict of interest statement

Declaration of competing interest None for any of the authors.

Figures

Fig. 1
Fig. 1
Electrocardiogram showing increase in tachycardia cycle length on transition from LBBB to narrow QRS LBBB- Left bundle branch block.
Fig. 2
Fig. 2
Same as Fig. 1 with intracardiac recordings CS 9, 10 to CS 1,2 – coronary sinus proximal to distal, Hisd, Hism and His p- His distal to proximal, HRA-high right atrium, RV- right ventricle.
Fig. 3
Fig. 3
AH jump (55 ms) produced by 10 ms decrement in atrial extrastimulus suggesting dual AV nodal physiology. Stimulation was done from mid coronary sinus electrodes (not shown in the image).
See this image and copyright information in PMC

References

    1. Coumel P., Attuel P. Reciprocating tachycardia in overt and latent preexcitation. Influence of functional bundle branch block on the rate of the tachycardia. Eur J Cardiol. 1974;1(4):423–436. - PubMed
    1. Extramiana F., Takatsuki S., Hayashi M., Leenhardt A. Functional bundle branch block and orthodromic reciprocating tachycardia cycle length: do not bet on accessory pathway location. Europace. 2007;9(10):920–922. - PubMed