Background Localization of atrioventricular accessory pathways (AP) from Electrocardiogram (ECG) is crucial for successful ablation. We analyzed the value of limb lead 2 versus 3 QRS vector discordance on surface ECG among right‐sided pathways. Methods Data from consecutive patients undergoing successful ablation of manifest AP were analyzed. They were categorized into two groups—Gr I: Endocardial ablation from anterior and anterolateral tricuspid annulus (TA, 10−1 o'clock, right anterolateral [RAL]); Gr II: Ablation outside this region (1−10 o'clock of TA). Inferior lead discordance (ILD) was defined as positive QRS complex (monophasic R, Rs) in lead 2 with negative/equiphasic QRS vector in lead 3 (rS, S, RS). Maximally pre‐excited ECGs during electrophysiology study were compared for presence of ILD. Result Among total 22 cases (Age 36 ± 18 years, 12 males), ILD was noted in 4/4 cases of Gr I. It was absent among 17/18 cases of right‐sided AP in Gr II. The only case in Gr II having ILD was ablated near 8 o'clock (posterolateral). In contrast to the other four cases, aVF was negative, along with lead 3. A close differential was mid‐septal AP (MSAP). However, the MSAP had absence of r in V1 and lead 2 having rS/RS complex in contrast to strongly positive QRS in RAL pathways. The sensitivity and specificity of ILD for RAL are 100% and 95%, respectively. The positive, negative predictive value, and accuracy are 80%, 100%, and 95%, respectively. Conclusion Positive QRS complex in lead 2 with negative QRS in lead 3 in maximally pre‐excited ECG is often predictive of anterior and anterolateral location among right‐sided pathways.

Pseudoaneurysms are among very rare complications of maxillofacial trauma. When encountered, they have the potential to cause life-threatening hemorrhage. A wise surgeon should consider the possibility of underlying aneurysm even if the classic sign of pulsatile mass is not present. The role of interventional radiology is immaculate in the management of these aneurysms.

An 18-year-old lady, a patient of Takayasu arteritis was referred to our hospital with a history of recurrent giddiness and resistant hypertension for 6 months. On examination, she had weak left carotid and left arm pulses and bilateral renal bruit. Investigations revealed bilateral renal artery stenosis with preserved renal size and architecture. Transthoracic echocardiogram (TTE) showed concentric left ventricular hypertrophy with ejection fraction of 50% and type I diastolic dysfunction. The aortic

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