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What Happened in these two tracings, Both EGM tracings are of same Patient

 

Intracardiac Tracing 1

Intracardiac Tracing case Electrophysiology
Intracardiac Tracing 2

In the first tracing, Surface ECG showing upright P waves in lead 1 , sinus rhythm, four complexes visible on the tracing, every p wave being followed by qrs, pre-excitation or delta wave is not evident
Ablation catheter showing large negative unipolar deflection occuring before the onset of QRS.

His catheter is likely more in the RV, His signal not visible, large V signals
On CS earliest activation is at 7,8 and A and V signals are more close in CS 1,2

In the second tracing same findings but in the end of tracing atrial activation sequence is changed with 9,10 leading

Conclusion:
Likely diagnosis Left Sided concealed Pathway being ablated.

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