1
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Scaglione M, Cerrato N, Spinoni EG, Battaglia A, Geuna F, Caponi D. Electroanatomic visualization of reentrant circuit of left fascicular ventricular tachycardia guiding a fluoroless ablation. HeartRhythm Case Rep 2023; 9:745-748. [PMID: 38047191 PMCID: PMC10691950 DOI: 10.1016/j.hrcr.2023.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Affiliation(s)
- Marco Scaglione
- Division of Cardiology, Cardinal Massaia Hospital, Asti, Italy
| | | | | | | | - Francesco Geuna
- Division of Cardiology, Cardinal Massaia Hospital, Asti, Italy
| | - Domenico Caponi
- Division of Cardiology, Cardinal Massaia Hospital, Asti, Italy
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2
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Idiopathic Ventricular Tachycardia. J Clin Med 2023; 12:jcm12030930. [PMID: 36769578 PMCID: PMC9918172 DOI: 10.3390/jcm12030930] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 01/06/2023] [Accepted: 01/16/2023] [Indexed: 01/27/2023] Open
Abstract
Idiopathic ventricular tachycardia (VT) is an important cause of morbidity and less commonly, mortality in patients with structurally normal hearts. Appropriate diagnosis and management are predicated on an understanding of the mechanism, relevant cardiac anatomy, and associated ECG signatures. Catheter ablation is a viable strategy to adequately treat and potentially provide a cure in patients that are intolerant to medications or when these are ineffective. In this review, we discuss special approaches and considerations for effective and safe ablation of VT arising from the right ventricular outflow tract, left ventricular outflow tract, left ventricular fascicles, papillary muscles, and moderator band.
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3
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Ono K, Iwasaki YK, Akao M, Ikeda T, Ishii K, Inden Y, Kusano K, Kobayashi Y, Koretsune Y, Sasano T, Sumitomo N, Takahashi N, Niwano S, Hagiwara N, Hisatome I, Furukawa T, Honjo H, Maruyama T, Murakawa Y, Yasaka M, Watanabe E, Aiba T, Amino M, Itoh H, Ogawa H, Okumura Y, Aoki-Kamiya C, Kishihara J, Kodani E, Komatsu T, Sakamoto Y, Satomi K, Shiga T, Shinohara T, Suzuki A, Suzuki S, Sekiguchi Y, Nagase S, Hayami N, Harada M, Fujino T, Makiyama T, Maruyama M, Miake J, Muraji S, Murata H, Morita N, Yokoshiki H, Yoshioka K, Yodogawa K, Inoue H, Okumura K, Kimura T, Tsutsui H, Shimizu W. JCS/JHRS 2020 Guideline on Pharmacotherapy of Cardiac Arrhythmias. Circ J 2022; 86:1790-1924. [DOI: 10.1253/circj.cj-20-1212] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
| | - Yu-ki Iwasaki
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Masaharu Akao
- Department of Cardiovascular Medicine, National Hospital Organization Kyoto Medical Center
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine
| | - Kuniaki Ishii
- Department of Pharmacology, Yamagata University Faculty of Medicine
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yoshinori Kobayashi
- Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital
| | | | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
| | - Naohiko Takahashi
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University
| | - Shinichi Niwano
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | | | | | - Tetsushi Furukawa
- Department of Bio-information Pharmacology, Medical Research Institute, Tokyo Medical and Dental University
| | - Haruo Honjo
- Research Institute of Environmental Medicine, Nagoya University
| | - Toru Maruyama
- Department of Hematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital
| | - Yuji Murakawa
- The 4th Department of Internal Medicine, Teikyo University School of Medicine, Mizonokuchi Hospital
| | - Masahiro Yasaka
- Department of Cerebrovascular Medicine and Neurology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center
| | - Eiichi Watanabe
- Department of Cardiology, Fujita Health University School of Medicine
| | - Takeshi Aiba
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Mari Amino
- Department of Cardiovascular Medicine, Tokai University School of Medicine
| | - Hideki Itoh
- Division of Patient Safety, Hiroshima University Hospital
| | - Hisashi Ogawa
- Department of Cardiology, National Hospital Organisation Kyoto Medical Center
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Chizuko Aoki-Kamiya
- Department of Obstetrics and Gynecology, National Cerebral and Cardiovascular Center
| | - Jun Kishihara
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Eitaro Kodani
- Department of Cardiovascular Medicine, Nippon Medical School Tama Nagayama Hospital
| | - Takashi Komatsu
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University School of Medicine
| | | | | | - Tsuyoshi Shiga
- Department of Clinical Pharmacology and Therapeutics, The Jikei University School of Medicine
| | - Tetsuji Shinohara
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University
| | - Atsushi Suzuki
- Department of Cardiology, Tokyo Women's Medical University
| | - Shinya Suzuki
- Department of Cardiovascular Medicine, The Cardiovascular Institute
| | - Yukio Sekiguchi
- Department of Cardiology, National Hospital Organization Kasumigaura Medical Center
| | - Satoshi Nagase
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Noriyuki Hayami
- Department of Fourth Internal Medicine, Teikyo University Mizonokuchi Hospital
| | | | - Tadashi Fujino
- Department of Cardiovascular Medicine, Toho University, Faculty of Medicine
| | - Takeru Makiyama
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Mitsunori Maruyama
- Department of Cardiovascular Medicine, Nippon Medical School Musashi Kosugi Hospital
| | - Junichiro Miake
- Department of Pharmacology, Tottori University Faculty of Medicine
| | - Shota Muraji
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
| | | | - Norishige Morita
- Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital
| | - Hisashi Yokoshiki
- Department of Cardiovascular Medicine, Sapporo City General Hospital
| | - Koichiro Yoshioka
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine
| | - Kenji Yodogawa
- Department of Cardiovascular Medicine, Nippon Medical School
| | | | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School
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4
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Sung RK, Boyden PA, Higuchi S, Scheinman M. Diagnosis and Management of Complex Reentrant Arrhythmias Involving the His-Purkinje System. Arrhythm Electrophysiol Rev 2021; 10:190-197. [PMID: 34777824 PMCID: PMC8576512 DOI: 10.15420/aer.2021.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 07/13/2021] [Indexed: 11/04/2022] Open
Abstract
The His-Purkinje system is a network of bundles and fibres comprised of specialised cells that allow for coordinated, synchronous activation of the ventricles. Although the histology and physiology of the His-Purkinje system have been studied for more than a century, its role in ventricular arrhythmias has recently been discovered with the ongoing elucidation of the mechanisms leading to both benign and life-threatening arrhythmias. Studies of Purkinje-cell electrophysiology show multiple mechanisms responsible for ventricular arrhythmias, including enhanced automaticity, triggered activity and reentry. The variation in functional properties of Purkinje cells in different areas of the His-Purkinje system underlie the propensity for reentry within Purkinje fibres in structurally normal and abnormal hearts. Catheter ablation is an effective therapy in nearly all forms of reentrant arrhythmias involving Purkinje tissue. However, identifying those at risk of developing fascicular arrhythmias is not yet possible. Future research is needed to understand the precise molecular and functional changes resulting in these arrhythmias.
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Affiliation(s)
| | | | - Satoshi Higuchi
- University of California San Francisco, San Francisco, CA, US
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5
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Transcatheter radiofrequency ablation using near-zero fluoroscopy in children with fascicular ventricular tachycardia: a single-centre experience. Cardiol Young 2020; 30:779-784. [PMID: 32383414 DOI: 10.1017/s104795112000102x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Fascicular tachycardia is a common form of sustained idiopathic left ventricular tachycardia. This study aimed to achieve successful results with catheter ablation procedures performed through three-dimensional electroanatomic mapping using near-zero fluoroscopy in fascicular tachycardia patients. METHODS AND RESULTS In this study, we included 33 consecutive children with fascicular tachycardia, for whom we performed a transcatheter radiofrequency ablation procedure using the EnSite® system. Activation mapping was performed in all patients during tachycardia, and the earliest presystolic purkinje potentials were the target site for radiofrequency lesions. RESULTS Twenty-five patients were male, and eight were female. The mean weight of the patients was 39.6 ± 10.4 kg, and the mean age was 13.6 ± 2.5 years. The mean procedure time was 121.3 ± 44.3 minutes. The mean follow-up period was 18.4 ± 6.5 months. No fluoroscopy was needed in 30 patients. The mean fluoroscopy time in the remaining patients was 166.6 ± 80 seconds. All of the patients had left posterior fascicular tachycardia except for one who had left anterior fascicular tachycardia. The acute success rate was perfect (100%). No patients developed left bundle branch block or complete atrioventricular block. Recurrence developed in one patient. CONCLUSION We suggest that radiofrequency ablations via an electroanatomic mapping system are quite safe and effective, with high success rates in paediatric patients with fascicular tachycardia. This method has the advantage of avoiding ionising radiation exposure for both the patient and operator, thus reducing the lifetime risk of malignancy in the paediatric population.
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6
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Chen H, Chan K, Po SS, Chen M. Idiopathic Left Ventricular Tachycardia Originating in the Left Posterior Fascicle. Arrhythm Electrophysiol Rev 2020; 8:249-254. [PMID: 32685155 PMCID: PMC7358963 DOI: 10.15420/aer.2019.07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Ventricular tachycardias originating from the Purkinje system are the most common type of idiopathic left ventricular tachycardia. The majority if not all of the reentrant circuit involved in this type of tachycardia is formed by the Purkinje fibres of the left bundle branch, particularly the left posterior fascicle. In general, slowly conducting Purkinje fibres (P1) form the antegrade limb, and normally conducting Purkinje fibres (P2) form the retrograde limb of the reentrant circuit of the ventricular tachycardia originating from the left posterior fascicle. Elimination of the critical Purkinje elements in the reentrant circuit is the route to successful ablation. While the reentrant circuit identified by activation mapping provides the roadmap to ablation targets, comparing the difference in the His-ventricular interval during sinus rhythm and tachycardia also helps to identify the critical site in the reentrant circuit.
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Affiliation(s)
- Hongwu Chen
- Division of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Kit Chan
- Division of Cardiology, University of Hong Kong Shenzhen Hospital, Shenzhen, China
| | - Sunny S Po
- Section of Cardiovascular Diseases and Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, US
| | - Minglong Chen
- Division of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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7
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The electrocardiogram in the age of three-dimensional mapping: What is the secret of its youth? REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.repce.2019.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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8
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Creta A, Chow AW, Sporton S, Finlay M, Papageorgiou N, Honarbakhsh S, Dhillon G, Graham A, Patel KH, Dhinoja M, Earley MJ, Hunter RJ, Lowe M, Rowland E, Segal OR, Calabrese V, Ricciardi D, Lambiase PD, Schilling RJ, Providência R. Catheter ablation for fascicular ventricular tachycardia: A systematic review. Int J Cardiol 2019; 276:136-148. [DOI: 10.1016/j.ijcard.2018.10.080] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 10/03/2018] [Accepted: 10/24/2018] [Indexed: 11/24/2022]
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9
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Eletrocardiograma na era do mapeamento tridimensional. Qual o segredo da sua juventude? Rev Port Cardiol 2019; 38:93-95. [DOI: 10.1016/j.repc.2019.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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10
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Sohinki DA, Mathew ST. Ventricular Arrhythmias in the Patient with a Structurally Normal Heart. J Innov Card Rhythm Manag 2018; 9:3338-3353. [PMID: 32477784 PMCID: PMC7252725 DOI: 10.19102/icrm.2018.091004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 02/04/2018] [Indexed: 11/24/2022] Open
Abstract
Ventricular arrhythmias (VAs) are among the most common cardiac rhythm disturbances encountered in clinical practice. Patients presenting with frequent ventricular ectopy or sustained ventricular tachycardia represent a challenging and worrisome clinical scenario for many practitioners because of concerning symptoms, frequent associated acute hemodynamic compromise, and the adverse prognostic implications inherent to these cases. While an underlying structural or functional cardiac abnormality, metabolic derangement, or medication toxicity is often readily apparent, many patients have no obvious underlying condition, despite a comprehensive diagnostic evaluation. Such patients are diagnosed as having an idiopathic VA, which is a label with specific implications regarding arrhythmia origin, prognosis, and potential for pharmacologic and invasive management. Further, a subset of patients with otherwise benign idiopathic ventricular ectopy can present with polymorphic ventricular tachycardia and ventricular fibrillation, adding a layer of complexity to a clinical syndrome previously felt to have a benign clinical course. Thus, this review seeks to highlight the most common types of idiopathic VAs with a focus on their prognostic implications, underlying electrophysiologic mechanisms, unique electrocardiographic signatures, and considerations for invasive electrophysiologic study and catheter ablation. We further address some of the data regarding idiopathic ventricular fibrillation with respect to the heterogeneous nature of this diagnosis.
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Affiliation(s)
- Daniel A Sohinki
- Department of Cardiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Sunil T Mathew
- Department of Cardiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.,Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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11
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Yang Y, Liu Q, Luo X, Liu Z, Zhou S. Insights on the pulmonary artery-derived ventricular arrhythmia. J Cardiovasc Electrophysiol 2018; 29:1330-1337. [PMID: 29864191 DOI: 10.1111/jce.13652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 05/16/2018] [Accepted: 05/18/2018] [Indexed: 11/30/2022]
Abstract
Pulmonary artery-derived ventricular arrhythmia is gradually being recognized, which in a clinical context is recognized as an arterial ectopic beat. Our study aimed to provide new insights on the epidemiological characteristics, origin site, electrocardiogram (ECG) characteristics, intracardiac electrophysiological characteristics and radiofrequency catheter ablation (RFCA) strategies for pulmonary artery-derived ventricular arrhythmia. Patients with a distance between the origin site and the pulmonary valve of >10 mm have what is known as pulmonary trunk-derived ventricular arrhythmia, while patients with a distance between the origin site and the pulmonary valve of ≤10 mm have what is known as pulmonary sinus cusp-derived ventricular arrhythmia. It is very difficult to differentiate pulmonary artery-derived ventricular arrhythmia from right ventricular outflow tract-derived ventricular arrhythmia on ECGs as both share similar anatomical features, but pulmonary artery-derived ventricular arrhythmia shows obvious intracardiac electrophysiological characteristics. Currently, conclusions based on the epidemiological characteristics of pulmonary artery-derived ventricular arrhythmia, relationship between the origin site and the pulmonary valve, electrophysiological characteristics, and RFCA strategies are controversial and still need further study.
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Affiliation(s)
- Yufan Yang
- Cardiac Catheterization Lab of Second Xiangya Hospital attached to Central South University, Hunan, People's Republic of China.,Department of Cardiology of Second Xiangya Hospital attached to Central South University, Hunan, People's Republic of China
| | - Qiming Liu
- Cardiac Catheterization Lab of Second Xiangya Hospital attached to Central South University, Hunan, People's Republic of China.,Department of Cardiology of Second Xiangya Hospital attached to Central South University, Hunan, People's Republic of China
| | - Xijin Luo
- Cardiac Catheterization Lab of Second Xiangya Hospital attached to Central South University, Hunan, People's Republic of China.,Department of Cardiology of Second Xiangya Hospital attached to Central South University, Hunan, People's Republic of China
| | - Zhenjiang Liu
- Cardiac Catheterization Lab of Second Xiangya Hospital attached to Central South University, Hunan, People's Republic of China.,Department of Cardiology of Second Xiangya Hospital attached to Central South University, Hunan, People's Republic of China
| | - Shenghua Zhou
- Cardiac Catheterization Lab of Second Xiangya Hospital attached to Central South University, Hunan, People's Republic of China.,Department of Cardiology of Second Xiangya Hospital attached to Central South University, Hunan, People's Republic of China
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12
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Drago F, Battipaglia I, Di Mambro C. Neonatal and Pediatric Arrhythmias: Clinical and Electrocardiographic Aspects. Card Electrophysiol Clin 2018; 10:397-412. [PMID: 29784491 DOI: 10.1016/j.ccep.2018.02.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Arrhythmias have acquired a specific identity in pediatric cardiology, but for pediatric cardiologists it has always been difficult to recognize and treat them. Changes in anatomy and physiology result in electrocardiogram features that differ from the normal adult pattern and vary according to the age of the child. Sinus arrhythmia, ectopic atrial rhythm, "wandering pacemaker," and junctional rhythm can be normal characteristics in children (15%-25% of healthy children can have these rhythms on the electrocardiogram). Tachyarrhythmias and bradyarrhythmias must be treated according to the severity of symptoms, and the patient's age and weight.
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Affiliation(s)
- Fabrizio Drago
- Paediatric Cardiology and Cardiac Arrhythmias Unit, Department of Paediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital and Research Institute, Piazza Sant'Onofrio 4, Rome 00165, Italy.
| | - Irma Battipaglia
- Paediatric Cardiology and Cardiac Arrhythmias Unit, Department of Paediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital and Research Institute, Piazza Sant'Onofrio 4, Rome 00165, Italy
| | - Corrado Di Mambro
- Paediatric Cardiology and Cardiac Arrhythmias Unit, Department of Paediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital and Research Institute, Piazza Sant'Onofrio 4, Rome 00165, Italy
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13
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Ching S, Yue CS. Man With Heart Palpitations. Ann Emerg Med 2018; 71:470-472. [PMID: 29566889 DOI: 10.1016/j.annemergmed.2017.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Shing Ching
- Division of Cardiology, Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong, China
| | - Chiu Sun Yue
- Division of Cardiology, Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong, China
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14
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Kawakami H, Aiba T, Ishibashi K, Nakajima I, Wada M, Kamakura T, Inoue Y, Miyamoto K, Okamura H, Nagase S, Noda T, Kokubo Y, Miyamoto Y, Yasuda S, Kamakura S, Kusano K. Change in QRS morphology as a marker of spontaneous elimination in verapamil-sensitive idiopathic left ventricular tachycardia. J Cardiovasc Electrophysiol 2017; 29:446-455. [PMID: 29226995 DOI: 10.1111/jce.13403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 11/14/2017] [Accepted: 11/29/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Verapamil-sensitive idiopathic left ventricular tachycardia (verapamil-ILVT) is thought to be due to a reentry within the LV fascicular system. Radiofrequency catheter ablation (RFCA) is effective for elimination of the VT; however, a long-term prognosis of patients with verapamil-ILVT is still unclear. METHODS AND RESULTS Eighty consecutive verapamil-ILVT patients (62 men, 31 ± 12 years of age, LVEF: 65 ± 4%) were enrolled. Seventy-six (95%) cases of VT involved right bundle branch block and left axis deviation. We retrospectively analyzed changes in the QRS duration (ΔQRS-d) and QRS axis (ΔQRS-axis) during follow-up and compared them with recurrence of VT. During a mean follow-up period of 10 years (2-32 years), no sudden death or heart failure occurred. Fifty-one (64%) patients underwent RFCA, and 46 (90%) of them had no VT without any medication after RFCA. The ΔQRS-d (16 ± 2 vs. 8 ± 1 ms, P = 0.24) and ΔQRS-axis (20 ± 4 vs. 4 ± 3 degrees, P = 0.23) were not different in patients with no VT (VT[-]) and those with recurrence of VT (VT[+]). However, in the remaining 29 patients without RFCA, VT was spontaneously eliminated in 16 patients. The ΔQRS-d (30 ± 6 vs. 6 ± 1 ms, P = 0.002) and ΔQRS-axis (23 ± 4 vs. 5 ± 2 degrees, P = 0.001) were significantly larger in VT(-) patients compared to VT(+) patients during follow-up. CONCLUSIONS Some verapamil-ILVT patients who show QRS morphology changes over the follow-up period may become free from VT without any invasive or pharmacological treatments, suggesting that further altered LV fascicular conduction might eliminate the reentry of verapamil-ILVT.
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Affiliation(s)
- Hiroshi Kawakami
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Takeshi Aiba
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kohei Ishibashi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Ikutaro Nakajima
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Mitsuru Wada
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Tsukasa Kamakura
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yuko Inoue
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Koji Miyamoto
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hideo Okamura
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Satoshi Nagase
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Takashi Noda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yoshihiro Kokubo
- Department of Preventive Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yoshihiro Miyamoto
- Department of Preventive Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Shiro Kamakura
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
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15
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Yang Y, Liu Q, Liu Z, Zhou S. Treatment of pulmonary sinus cusp-derived ventricular arrhythmia with reversed U-curve catheter ablation. J Cardiovasc Electrophysiol 2017; 28:768-775. [PMID: 28467672 DOI: 10.1111/jce.13236] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 03/28/2017] [Accepted: 04/03/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Yufan Yang
- Cardiac Catheterization Lab of Second Xiangya Hospital attached to Central South University; Changsha Hunan 410011 China
- Department of Cardiology of Second Xiangya Hospital attached to Central South University; Changsha Hunan 410011 China
| | - Qiming Liu
- Cardiac Catheterization Lab of Second Xiangya Hospital attached to Central South University; Changsha Hunan 410011 China
- Department of Cardiology of Second Xiangya Hospital attached to Central South University; Changsha Hunan 410011 China
| | - Zhenjiang Liu
- Cardiac Catheterization Lab of Second Xiangya Hospital attached to Central South University; Changsha Hunan 410011 China
- Department of Cardiology of Second Xiangya Hospital attached to Central South University; Changsha Hunan 410011 China
| | - Shenghua Zhou
- Cardiac Catheterization Lab of Second Xiangya Hospital attached to Central South University; Changsha Hunan 410011 China
- Department of Cardiology of Second Xiangya Hospital attached to Central South University; Changsha Hunan 410011 China
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16
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Alahmad Y, Asaad NA, Arafa SO, Ahmad Khan SH, Mahmoud A. Idiopathic Fascicular Left Ventricular Tachycardia. Heart Views 2017; 18:83-87. [PMID: 29184614 PMCID: PMC5686933 DOI: 10.4103/heartviews.heartviews_145_15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Idiopathic left fascicular ventricular tachycardia (ILFVT) is characterized by right bundle branch block morphology and left axis deviation. We report a case of idiopathic left ventricular fascicular tachycardia in a young 31-year-old male patient presenting with a narrow complex tachycardia.
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Affiliation(s)
- Yaser Alahmad
- Department of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Nidal Ahmad Asaad
- Department of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | | | - Alsayed Mahmoud
- Department of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
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17
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Abstract
Fascicular arrhythmias encompass a wide spectrum of ventricular arrhythmias that depend on the specialized conduction system of the right and left ventricles. These arrhythmias include premature ventricular complexes, monomorphic ventricular tachycardia, polymorphic ventricular tachycardia, and ventricular fibrillation. These arrhythmias may be organized by mechanism, including intrafascicular reentry, interfascicular reentry, and focal. Mapping and ablation of the fascicular system can result in high cure rates of debilitating and potentially life-threatening arrhythmias. When approaching these arrhythmias, careful consideration of the structure of the His Purkinje system as well as their electrophysiologic properties may help guide even the most complex of arrhythmias.
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Affiliation(s)
- Raphael Sung
- Community Hospital of the Monterey Peninsula, Monterey, CA, USA
| | - Melvin Scheinman
- University of California San Francisco, 350 Parnassus Avenue, #300, San Francisco, CA 94117, USA.
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Saeid AK, Klein GJ, Leong-Sit P. Sustained Ventricular Tachycardia in Apparently Normal Hearts: Medical Therapy Should be the First Step in Management. Card Electrophysiol Clin 2016; 8:631-639. [PMID: 27521096 DOI: 10.1016/j.ccep.2016.04.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Sustained monomorphic ventricular tachycardia or repetitive premature ventricular complexes can be seen in patients with structurally normal hearts. Among these types of patients, the prognosis is predominantly benign and the treatment mostly focused on elimination of symptoms rather than improving survival or reduction of mortality. This article focuses on the pharmacologic options for management and compares them with invasive options. Based on the current literature, we demonstrate that medical therapies should be used as first-line management and favored over invasive therapies. Understanding the arrhythmia mechanism is critical in choosing the appropriate medication among the wide variety of antiarrhythmic drugs available.
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Jacobson JT, Iwai S, Aronow W. Medical therapy to prevent recurrence of ventricular arrhythmia in normal and structural heart disease patients. Expert Rev Cardiovasc Ther 2016; 14:1251-1262. [PMID: 27494263 DOI: 10.1080/14779072.2016.1221342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Recurrent ventricular arrhythmias (VA) are a source of significant morbidity in patients without structural heart disease (SHD) and also mortality in patients with SHD. The treatment goals for these two patient populations differ greatly. Areas covered: The secondary prevention of recurrent VA in patients without and with SHD will be reviewed, focusing on clinical data (especially randomized, controlled trials) in the literature as determined through searches in PubMed and ClinicalTrials.gov. This will include β blockers, non-dihydropyridine calcium channel blockers and antiarrhythmic drugs in both subgroups and non-antiarrhythmic medications in SHD. Expert commentary: The available options for medical therapy for VA in both normal hearts and SHD are insufficient, due to substandard efficacy and toxicities. While non-pharmacologic therapies may provide an excellent option, further drug development and randomized trials are needed, as is a reappraisal of the current mode of utilization.
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Affiliation(s)
- Jason T Jacobson
- a Division of Cardiology, Department of Medicine, Westchester Medical Center , New York Medical College , Valhalla , NY , USA
| | - Sei Iwai
- a Division of Cardiology, Department of Medicine, Westchester Medical Center , New York Medical College , Valhalla , NY , USA
| | - Wilbert Aronow
- a Division of Cardiology, Department of Medicine, Westchester Medical Center , New York Medical College , Valhalla , NY , USA
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Lim VG, Yip KP, Lim ZY, Sporton S, Kennon S. The 'Normal' Heart: Fascicular Ventricular Tachycardia. Am J Med 2016; 129:580-2. [PMID: 26899748 DOI: 10.1016/j.amjmed.2016.01.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Revised: 01/20/2016] [Accepted: 01/20/2016] [Indexed: 11/25/2022]
Affiliation(s)
- Ven Gee Lim
- Royal Wolverhampton NHS Trust, Wolverhampton, West Midlands, UK
| | - Kay Por Yip
- Worcestershire Acute Hospitals NHS Trust, Worcester, UK.
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Capítulo 10. Utilidad del mapeo tridimensional en la ablación de la taquicardia ventricular fascicular (corazón sano). REVISTA COLOMBIANA DE CARDIOLOGÍA 2016. [DOI: 10.1016/j.rccar.2016.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Liu E, Xu G, Liu T, Ye L, Zhang Q, Zhao Y, Li G. Discrete potentials guided radiofrequency ablation for idiopathic outflow tract ventricular arrhythmias. Europace 2015; 17:453-460. [PMID: 25179648 DOI: 10.1093/europace/euu184] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023] Open
Abstract
AIMS Discrete potentials (DPs) have been recorded and targeted as the site of ablation of the outflow tract arrhythmias. The aim of the present study was to investigate the significance of DPs with respect to mapping and ablation for idiopathic outflow tract premature ventricular contractions (PVCs) or ventricular tachycardias (VTs). METHODS AND RESULTS Seventeen consecutive patients with idiopathic right or left ventricular outflow tract PVCs/VTs who underwent radiofrequency catheter ablation were included. Intracardiac electrograms during the mapping and ablation were analysed. During sinus rhythm, sharp high-frequency DPs that displayed double or multiple components were recorded following or buried in the local ventricular electrograms in all of the 17 patients, peak amplitude 0.51 ± 0.21 mV. The same potential was recorded prior to the local ventricular potential of the PVCs/VTs. Spontaneous reversal of the relationship of the DPs to the local ventricular electrogram during the arrhythmias was noted. The DPs were related to a region of low voltage showed by intracardiac high-density contact mapping. At the sites with DPs, lower unipolar and bipolar ventricular voltage of sinus beats were noted compared with the adjacent regions without DPs (unipolar: 6.1 ± 1.8 vs. 8.3 ± 2.3 mV, P < 0.05; bipolar: 0.62 ± 0.45 vs. 1.03 ± 0.60 mV, P < 0.05). The targeted DPs were still present in 12 patients after successful elimination of the ectopies. Discrete potentials were not present in seven controls. CONCLUSION Discrete potentials and related low-voltage regions were common in idiopathic outflow tract ventricular arrhythmias. Discrete potential- and substrate-guided ablation strategy will help to reduce the recurrence of idiopathic outflow tract arrhythmias.
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Affiliation(s)
- Enzhao Liu
- Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, People's Republic of China
| | - Gang Xu
- Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, People's Republic of China
| | - Tong Liu
- Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, People's Republic of China
| | - Lan Ye
- Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, People's Republic of China
| | - Qitong Zhang
- Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, People's Republic of China
| | - Yanshu Zhao
- Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, People's Republic of China
| | - Guangping Li
- Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, People's Republic of China
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Canan T, Vaseghi M, Girsky MJ, Yang EH. A complex rhythm treated simply: fascicular ventricular tachycardia. Am J Med 2014; 127:601-4. [PMID: 24316058 DOI: 10.1016/j.amjmed.2013.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Revised: 11/20/2013] [Accepted: 11/20/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Timothy Canan
- Department of Medicine, University of California at Los Angeles, Los Angeles, Calif
| | - Marmar Vaseghi
- Division of Cardiology, University of California at Los Angeles, Los Angeles, Calif
| | - Marc J Girsky
- Division of Cardiology, Department of Medicine, Harbor-UCLA Medical Center, Torrance, Calif
| | - Eric H Yang
- Division of Cardiology, University of California at Los Angeles, Los Angeles, Calif.
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Crosson JE, Callans DJ, Bradley DJ, Dubin A, Epstein M, Etheridge S, Papez A, Phillips JR, Rhodes LA, Saul P, Stephenson E, Stevenson W, Zimmerman F. PACES/HRS expert consensus statement on the evaluation and management of ventricular arrhythmias in the child with a structurally normal heart. Heart Rhythm 2014; 11:e55-78. [PMID: 24814375 DOI: 10.1016/j.hrthm.2014.05.010] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Indexed: 01/02/2023]
Affiliation(s)
- Jane E Crosson
- Bloomberg Children's Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David J Callans
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Anne Dubin
- Lucile Packard Children's Hospital, Stanford School of Medicine, Stanford, California
| | | | - Susan Etheridge
- University of Utah and Primary Children's Medical Center, Salt Lake City, Utah
| | - Andrew Papez
- Phoenix Children's Hospital/Arizona Pediatric Cardiology Consultants Phoenix, Arizona
| | | | | | - Philip Saul
- Nationwide Children's Hospital, Ohio State University, Columbus, Ohio
| | | | - William Stevenson
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Frank Zimmerman
- Advocate Heart Institute for Children Advocate Children's Hospital, Oak Lawn, Illinois.
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Morgera T, Hrovatin E, Mazzone C, Humar F, De Biasio M, Salvi A. Clinical spectrum of fascicular tachycardia. J Cardiovasc Med (Hagerstown) 2013; 14:791-8. [DOI: 10.2459/jcm.0b013e32835ef0b6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Pino R, Sciortino G, Polizzi G. Brugada-like phenomenon, induced by intravenous propafenone, in a patient with idiopathic fascicular ventricular tachycardia. J Cardiovasc Med (Hagerstown) 2013; 14:380-3. [DOI: 10.2459/jcm.0b013e328339d8f7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Kane A, Defaye P, Jacon P, Mbaye A, Machecourt J. [Malignant fascicular ventricular tachycardia degenerating into ventricular fibrillation in a patient with early repolarization syndrome]. Ann Cardiol Angeiol (Paris) 2012; 61:292-295. [PMID: 21665187 DOI: 10.1016/j.ancard.2011.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2011] [Accepted: 05/02/2011] [Indexed: 05/30/2023]
Abstract
A 45-year-old man was hospitalized for syncope due to fascicular ventricular tachycardia degenerating into ventricular fibrillation (VF). The electrocardiogram showed an early repolarization syndrome. The arrhythmia was repetitive and disappeared after oral hydroquinidine. An implantable cardioverter-defibrillator (ICD) was implanted; subsequently, the patient was arrhythmia free at 9 months follow-up.
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Affiliation(s)
- Ad Kane
- Unité d'arythmie, département de cardiologie, CHU Michallon, BP 217X, 38043 Grenoble cedex 09, France.
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Prystowsky EN, Padanilam BJ, Joshi S, Fogel RI. Ventricular Arrhythmias in the Absence of Structural Heart Disease. J Am Coll Cardiol 2012; 59:1733-44. [PMID: 22575310 DOI: 10.1016/j.jacc.2012.01.036] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 12/22/2011] [Accepted: 01/06/2012] [Indexed: 11/25/2022]
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Hamid N, Chia S. Case of Idiopathic Left Ventricular Tachycardia (ILVT). PROCEEDINGS OF SINGAPORE HEALTHCARE 2011. [DOI: 10.1177/201010581102000409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: The objective of this case report is to illustrate a case of idiopathic left ventricular tachycardia (ILVT). It is important to distinguish key features to differentiate ILVT from other types of ventricular tachycardias. Clinical picture: A 33-year-old male presented with palpitations. Clinical examination was unremarkable, except a heart rate of 170 beats/min. ECG showed a right bundle branch morphology, left superior frontal plane and a relatively narrow QRS duration. A diagnosis of ILVT was made. Treatment: Intravenous verapamil was given and the ILVT was terminated. Conclusion: ILVT differs from other types of VT, such as right ventricular outflow tract (RVOT), in terms of mechanisms, site of origin and management. Overall, ILVT has a good prognosis, compared to VTs seen in ischaemic cardiomyopathy.
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Affiliation(s)
- Nadira Hamid
- Department of Cardiology, National Heart Centre Singapore
| | - Stanley Chia
- Department of Cardiology, National Heart Centre Singapore
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Sellal JM, Brembilla-Perrot B, Suty-Selton C, Sadoul N, Huttin O. Ventricular tachycardia without apparent heart disease: long-term follow-up. J Electrocardiol 2011; 44:786-91. [PMID: 21419424 DOI: 10.1016/j.jelectrocard.2011.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Indexed: 11/28/2022]
Abstract
UNLABELLED The purpose of the study was to evaluate the long-term prognosis of ventricular tachycardia (VT) in patients without structural heart disease (HD). METHODS Holter monitoring, exercise test, echocardiography, right angiography, coronary angiography, and electrophysiologic study were performed in 810 patients with VT. RESULTS Eighty patients (mean age, 45 ± 17 years) had no apparent HD. VT was reproduced at electrophysiologic study in 62 patients. Mean follow-up was 9.7 ± 7 years. Initially, 91% were treated with drugs. Defibrillator was implanted in 4, including 2 for arrhythmogenic right ventricular cardiomyopathy diagnosed later. VT ablation was performed in 3 patients. Three patients older than 70 years died of nonarrhythmic cause. Other patients are alive without antiarrhythmic drug treatment in 50%. Three developed a dilated cardiomyopathy; and 2, atrial fibrillation. CONCLUSIONS Invasive treatment was rarely required in patients with VT without HD. The prognosis was only dependent on the age and the pattern of electrocardiogram in VT.
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Ischemic etiology for adenosine-sensitive fascicular tachycardia. J Electrocardiol 2011; 44:217-21. [DOI: 10.1016/j.jelectrocard.2010.07.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2010] [Indexed: 11/20/2022]
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Roberts-Thomson KC, Lau DH, Sanders P. The diagnosis and management of ventricular arrhythmias. Nat Rev Cardiol 2011; 8:311-21. [DOI: 10.1038/nrcardio.2011.15] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Tada H, Tadokoro K, Miyaji K, Ito S, Kurosaki K, Kaseno K, Naito S, Nogami A, Oshima S, Taniguchi K. Idiopathic ventricular arrhythmias arising from the pulmonary artery: Prevalence, characteristics, and topography of the arrhythmia origin. Heart Rhythm 2008; 5:419-26. [DOI: 10.1016/j.hrthm.2007.12.021] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2007] [Accepted: 12/18/2007] [Indexed: 11/25/2022]
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Abstract
Idiopathic ventricular tachycardia (VT) is an uncommon form of VT that is seen in patients without structural heart disease. It is commonly seen in young patients and usually has a benign course. Recent studies have delineated the mechanisms and anatomical locations of this form of VT. Recognition of various forms of idiopathic VT based on characteristic QRS morphology from the 12-lead electrocardiogram (ECG) has important prognostic and therapeutic implications. The understanding of the mechanisms of idiopathic VT has led to the use of specific antiarrhythmic drugs targeting particular arrhythmias. Recent technological advances in the field of mapping and catheter ablation have led to a suitable alternative to drug therapy with a very high cure rate. This review describes the clinical features, ECG recognition, and management of idiopathic monomorphic VT.
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Lin D, Hsia HH, Gerstenfeld EP, Dixit S, Callans DJ, Nayak H, Russo A, Marchlinski FE. Idiopathic fascicular left ventricular tachycardia: Linear ablation lesion strategy for noninducible or nonsustained tachycardia. Heart Rhythm 2005; 2:934-9. [PMID: 16171747 DOI: 10.1016/j.hrthm.2005.06.009] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2005] [Accepted: 06/14/2005] [Indexed: 11/26/2022]
Abstract
BACKGROUND Idiopathic "fascicular" left ventricular tachycardia (IFLVT) is frequently not inducible or nonsustained at the time of planned catheter ablation. The mechanism of the arrhythmia has been suggested to be reentry involving a sizable area of the LV inferior septum extending from base toward the apex. OBJECTIVE We tested the ability of a series of radiofrequency lesions delivered in a linear fashion to the inferior-mid septum to control ventricular tachycardia not amenable to standard mapping ablation strategies. METHODS Programmed stimulation both at baseline state and with isoproterenol after heart rate was increased by at least 25% was performed in all patients. The patients included in the study were either non-inducible or only had brief nonsustained VT not amenable to "traditional" mapping. A detailed electroanatomic map of the LV was performed in sinus rhythm. The location of the linear lesion along the inferior septum was guided by the presence of Purkinje potentials, with pacemapping as an additional guide. A linear lesion was placed perpendicular to the long axis of the ventricle approximately midway from the base to the apex in the region of the mid to mid-inferior septum. Radiofrequency lesions were delivered using a 4mm tip catheter at 50 Watts and 52 degrees for 60-90 seconds. RESULTS Of 122 consecutive patients who underwent ablation of idiopathic VT from 1999 to 2003, 15 had IFLVT based on standard diagnostic criteria. Six of the 15 patients (40%) had nonsustained or no inducible VT in the EP lab. The number of RF lesions ranged from 7 to 15 (mean 9). The length of the effective linear lesion ranged from 1.2 to 2.2 cm (mean 1.7 cm). Development of left posterior fascicular block was noted in two of the six patients. However, despite the absence of development of left posterior fascicular block in the other four patients, no VT or premature ventricular beats could be induced after ablation using the same provocation maneuvers as performed in the baseline state. No spontaneous arrhythmias occurred during follow-up to 16 +/- 8 months (range 6 to 30 months). CONCLUSION In patients with difficult to induce or nonsustained VT with the typical right bundle branch block pattern and a superiorly directed axis on 12-lead ECG, RF energy ablation delivered in a linear fashion approximately midway to two thirds toward the apex along the mid to inferior septum and perpendicular to the plane of the septum is safe and effective for VT control.
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Affiliation(s)
- David Lin
- Hospital of the University of Pennsylvania, University of Pennsylvania Health Systems, Department of Medicine, Electrophysiology Section, Philadelphia, Pennsylvania 19104, USA.
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Kassotis J, Slesinger T, Festic E, Voigt L, Reddy CVR. Adenosine-sensitive wide-complex tachycardia: an uncommon variant of idiopathic fascicular ventricular tachycardia--a case report. Angiology 2003; 54:369-72. [PMID: 12785032 DOI: 10.1177/000331970305400315] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Most wide-complex tachycardias encountered in the emergency department (ED) are ventricular in origin, most commonly associated with structural heart disease. Ventricular tachyarrhythmias range in severity from life-threatening rhythms (eg, ventricular fibrillation and hemodynamically compromising ventricular tachycardia [VT]) to idiopathic forms of VT, which have a benign clinical course and a more favorable prognosis. The authors present the case of a 34-year-old woman who presented to the ED, with a wide-complex tachycardia with a right-bundle-branch block (RBBB) morphology and a right inferior axis, which was terminated with adenosine. The patient was previously misdiagnosed as suffering from a paroxysmal supraventricular tachycardia (SVT), which was unresponsive to beta-blocker therapy. Although the tachycardia responded to adenosine, suggestive of an SVT, the patient was referred to the arrhythmia service, where further work-up revealed an uncommon form of an idiopathic VT, originating from the left anterior fascicle. The authors discuss the unique electrocardiographic and electrophysiologic properties and useful diagnostic maneuvers required to properly identify this form of VT.
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Affiliation(s)
- John Kassotis
- Clinical Electrophysiologic Services, Division of Cardiology, Department of Medicine, New York Methodist Hospital, Brooklyn, NY 11215, USA.
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Dixit S, Marchlinski FE. Clinical characteristics and catheter ablation of left ventricular outflow tract tachycardia. Curr Cardiol Rep 2001; 3:305-13. [PMID: 11406089 DOI: 10.1007/s11886-001-0085-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Left ventricular outflow tract (LVOT) tachycardia is an uncommon form of idiopathic ventricular tachycardia (IVT). The underlying mechanism of this arrhythmia appears to be cyclic AMP-medicated triggered activity. The tachycardia occurs in the absence of structural heart disease and is generally benign, presenting commonly as palpitations and presyncope. It can manifest either a right or left bundle branch block morphology with an inferior axis. Subtle variations in the QRS morphology in leads I, V1, and V2 can help in localizing the anatomic site of origin (SOO). The arrhythmia is typically responsive to a variety of pharmacologic agents (beta-blockers, calcium channel blockers, Class I and II agents). Radiofrequency catheter ablation of LVOT tachycardia SOO as determined by pace mapping is quite efficacious (success rates of 90%). Magnetic electroanatomic mapping augments this by permitting three-dimensional catheter mapping and reproducible localization of the SOO. Catheter ablation should be considered relatively early in patients who experience severe symptoms with their arrhythmia and have failed, or are reluctant to take medications for the disorder.
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Affiliation(s)
- S Dixit
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Founders, 3400 Spruce Street, Philadelphia, PA 19104-4283, USA
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Yasui K, Shibata T, Yokoyama U, Nishizawa T, Takigiku K, Sakon T, Kobayashi H, Iwamoto M, Niimura I. Idiopathic sustained left ventricular tachycardia in pediatric patients. Pediatr Int 2001; 43:42-7. [PMID: 11207998 DOI: 10.1046/j.1442-200x.2001.01323.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Idiopathic sustained ventricular tachycardia originating from the left ventricle (ILVT) has been an indication for catheter ablation. The present study evaluated the clinical features, long-term prognosis and indications for treatment in pediatric patients with ILVT. METHODS The subjects of the present study were eight patients (four males and four females) with a mean age at onset of 11.0 years (range 3-15 years). The mean follow-up period was 7.7 years (range 2.1-11.3 years). RESULTS In electrophysiologic studies, intravenously administered verapamil was effective for the termination of tachycardia in all six patients who received this treatment and for the prevention of tachycardia in four of five patients. Oral administration of verapamil was effective in five of seven patients. Propranolol or flecainide was added to the treatment protocol for two patients who did not respond to verapamil alone. Tachycardia disappeared without drugs in four patients during the follow-up period and became non-sustained in another patient. Two of three patients with persistent tachycardia underwent catheter ablation. Pharmacologic treatment was very effective for ILVT among these patients. CONCLUSIONS Pharmacologic therapy, such as with verapamil, is still the treatment of choice for ILVT because of a good long-term prognosis and potential risks and complications by manipulation of catheter ablation.
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Affiliation(s)
- K Yasui
- Department of Pediatrics, Yokohama City University Medical Center, Yokohama, Japan.
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Abstract
The majority of patients who present with ventricular tachycardia have underlying structural heart disease. However, there has been increasing appreciation of the existence of multiple forms of idiopathic ventricular tachycardia with distinct features and unique mechanisms. The most common form of idiopathic ventricular tachycardia originates from the right ventricular outflow tract, is characterized by sensitivity to adenosine, and appears to be due to cyclic AMP-mediated triggered activity. Other forms of idiopathic ventricular tachycardia include intrafascicular left ventricular tachycardia, due to reentry, which is sensitive to verapamil, and automatic, propranolol-sensitive ventricular tachycardia.
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Affiliation(s)
- S Iwai
- Department of Medicine, Division of Cardiology, The New York Hospital-Cornell University Medical Center, 525 East 68th Street, Starr 409, New York, NY 10021, USA
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Abstract
Idiopathic ventricular tachycardia (VT) is characterized by two predominant forms. The most common form originates from the right ventricular outflow tract and presents as repetitive monomorphic VT or exercise-induced VT. The tachycardia is adenosine sensitive and is thought to be because of cAMP-mediated triggered activity. The other major form of idiopathic VT is owing to verapamil-sensitive intrafascicular re-entrant tachycardia, which most often originates in the region of the left posterior fascicle. Both forms of idiopathic VT can be readily treated with radiofrequency catheter ablation.
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Affiliation(s)
- B B Lerman
- Department of Medicine, New York Hospital-Cornell University Medical Center, New York, USA.
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Al-Sheikh T, Zipes DP. Guidelines for Competitive Athletes with Arrhythmias. DEVELOPMENTS IN CARDIOVASCULAR MEDICINE 2000. [DOI: 10.1007/978-94-017-0789-3_9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Bartolomé FB, Fernández-Bernal CS, Torres Feced V. Ablación con radiofrecuencia de la taquicardia ventricular izquierda idiopática en niños. Rev Esp Cardiol (Engl Ed) 2000. [DOI: 10.1016/s0300-8932(00)75142-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Most ventricular tachycardias encountered in clinical practice occur in patients who have structural heart disease. Idiopathic ventricular tachycardia refers to those arrhythmias that occur in patients without structural heart disease, metabolic/electrolyte abnormalities, or the long QT syndrome. Three commonly recognized forms of idiopathic ventricular tachycardia include: (a) ventricular tachycardia associated with mitral valve prolapse, (b) ventricular tachycardia originating from the right ventricular outflow tract, and (c) ventricular tachycardia originating from the left ventricle. Recently, a fourth type of idiopathic ventricular tachycardia, termed the Brugada syndrome, has been identified as responsible for some cases of cardiac arrest in persons without apparent structural heart disease. Each form of ventricular tachycardia may be considered a discrete syndrome based on its electrocardiographic characteristics, mechanisms, responses to pharmacologic intervention, and prognosis (good in most cases). Ventricular tachycardias range from the common to the exotic, but all represent syndromes with which the internist and general cardiologist should be familiar.
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Affiliation(s)
- G T Altemose
- Department of Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania 19140, USA
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46
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Niwano S, Furushima H, Taneda K, Abe A, Ohira K, Aizawa Y. The usefulness of Holter monitoring in selecting pharmacologic therapy for patients with sustained monomorphic ventricular tachycardia: studies in patients in whom no effective pharmacologic therapy could be determined by electrophysiologic study. JAPANESE CIRCULATION JOURNAL 1998; 62:347-52. [PMID: 9626902 DOI: 10.1253/jcj.62.347] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The usefulness of Holter monitoring (HM) in selecting pharmacologic therapy for patients with sustained monomorphic ventricular tachycardia (VT) was evaluated in patients in whom no effective pharmacologic therapy could be determined in an electrophysiologic study (EPS). The study population consisted of 49 consecutive patients with sustained VT who were receiving long-term pharmacologic therapy despite the fact that no pharmacologic therapy had been found to be effective in the EPS. The efficacy of the pharmacologic therapies was assessed by HM. A reduction in frequent (10/h) premature ventricular contractions (PVCs) was used as an index of treatment efficacy, with therapies achieving substantial PVC suppression (>70% of all PVCs) being considered to be effective (HM effective group). When no therapy was found to be effective when assessed by HM, a drug with any other beneficial effect, eg, reduction in VT rate, was chosen (HM ineffective group). VT recurrence and survival were compared between groups. During the follow-up period of 31+/-28 months, VT recurrence was observed in a total of 25/49 patients: 3/17 patients in the HM effective group, in 18/25 in the HM ineffective group, and in 4/7 in the HM undetermined group (p=0.0487). Sudden cardiac death occurred in a total 7/49 patients: 2/17 patients in the HM effective group, 4/25 patients in the HM ineffective group, and 1/7 patient in the HM undetermined group (p=0.2828). Among patients in whom no effective therapy could be determined by EPS, the VT recurrence rate was significantly lower in the group in whom treatment was effective as assessed by HM than among those in whom treatment was assessed by HM to be ineffective. Sudden cardiac death rate was also lowest in the HM effective group, although the difference was not statistically significant. HM assessment was considered useful in selection of pharmacologic therapy for patients in whom no effective therapy could be determined in the EPS.
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Affiliation(s)
- S Niwano
- First Department of Internal Medicine, Niigata University School of Medicine, Japan
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Tsai CF, Chen SA, Tai CT, Chiang CE, Ding YA, Chang MS. Idiopathic ventricular fibrillation: clinical, electrophysiologic characteristics and long-term outcomes. Int J Cardiol 1998; 64:47-55. [PMID: 9579816 DOI: 10.1016/s0167-5273(98)00004-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The long-term prognosis, including risks of arrhythmic recurrence of idiopathic ventricular fibrillation (VF), is uncertain; moreover, the role of electrophysiologic study in the diagnosis and guiding of antiarrhythmic drugs therapy for idiopathic VF remains controversial. The purpose of this study was to study the clinical features, electrophysiologic characteristics and long-term clinical outcomes of six consecutive patients (five males) who had at least one episode of aborted cardiac arrest (5 patients) or syncope (1 patients) with documentation of ventricular fibrillation (VF) in the absence of apparent heart disease. Idiopathic VF was diagnosed by exclusion. All patients underwent the electrophysiologic study including intravenous antiarrhythmic drug testing. Recurrences of VF after therapy and the long-term outcomes were assessed. The mean age at the first episode was 43+/-19 years (range from 16 to 63 years). All patients had sustained VF induced by double (3 patients) or triple (3 patients) ventricular extrastimuli at a paced cycle length of 400 or 500 ms from the right ventricular apex. Intravenous procainamide and/or mexiletine could suppress the reinduction of sustained VF in 4 (67%) of 6 patients. Recurrence of VF (documented VF attack, sudden cardiac arrest or syncope) was observed in 3 (100%) of 3 patients who received procainamide or mexiletine alone. Four patients (including 3 patients who experienced recurrence) received amiodarone alone or in combination with mexiletine, and these drugs could effectively prevent recurrence of VF. One patient with exercise-induced VF remained asymptomatic without any treatment during a follow-up period of 95 months. Another patient received an implantable cardioverter-defibrillator without concomitant antiarrhythmic drug therapy and had no discharge of electrical shock during 28 months of follow-up. During a mean follow-up period of 64+/-40 months (range from 28 to 128 months), all the patients were alive except patient No. 2 who died of acute hepatic failure. In conclusion, electrophysiologic study is a reliable diagnostic method, but it was of limited value in guiding antiarrhythmic drug therapy for preventing recurrence of idiopathic VF. Class I drug alone was associated with a high recurrence rate (100%) despite predictions that it would be effective by the electrophysiologic study. Amiodarone alone or in combination with mexiletine effectively prevented the recurrence of VF during the long-term follow-up along with a favourable outcome.
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Affiliation(s)
- C F Tsai
- Department of Medicine, National Yang-Ming University, School of Medicine, and Veterans General Hospital, Taipei, Taiwan, R.O.C
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48
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Benito Bartolomé F, Fernández-Bernal CS. Taquicardia ventricular izquierda idiopática en la infancia: control a largo plazo con verapamilo. Rev Esp Cardiol (Engl Ed) 1998. [DOI: 10.1016/s0300-8932(98)74742-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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49
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Tsai CF, Chen SA, Tai CT, Chiang CE, Lee SH, Wen ZC, Huang JL, Ding YA, Chang MS. Idiopathic monomorphic ventricular tachycardia: clinical outcome, electrophysiologic characteristics and long-term results of catheter ablation. Int J Cardiol 1997; 62:143-50. [PMID: 9431865 DOI: 10.1016/s0167-5273(97)00198-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Ventricular tachycardia (VT) without structural heart disease or any identifiable predisposing causes for arrhythmia is an uncommon but well-recognized clinical entity. The purpose of this study is to assess the results of catheter ablation therapy and the long-term outcome of patients with idiopathic monomorphic VT in a large patient group. Sixty-one consecutive patients (male/female=40/21; mean age 38+/-16 years) with idiopathic VT underwent electrophysiologic study and an attempt of catheter ablation therapy. The 'left VT' group included 31 patients with QRS morphology of right bundle branch block during VT suggestive of the VT originating from the left ventricle (LV), and the 'right VT' group consisted of 30 patients with QRS morphology of left bundle branch block with normal or right frontal axis deviation suggestive of VT arising from right ventricular outflow tract (RVOT). Idiopathic left VT has sustained VT during the clinical attacks, baseline electrophysiologic study or after isoproterenol infusion; it can be entrained by overdrive ventricular pacing, terminated by verapamil, but not by adenosine (except one case with VT focus at left ventricular free wall). Catheter ablation was successful in 22 (84%) of 26 patients, with recurrence rate of 9%. The successful ablation sites were located at LV inferior-apical septum (16 patients), mid-septum (three patients), high septum (two patients) and high anterior wall (one patient). In the right VT group, 20 (67%) of 30 patients presented clinically repetitive monomorphic VT. Most of the idiopathic right VT (22/30) required isoproterenol to facilitate induction of VT, and were sensitive to both verapamil and adenosine. Successful catheter ablation was achieved in 21 (84%) of 25 patients, with recurrence rate 19%. The successful ablation sites were located at RVOT-septum in 18 patients, and RVOT-free wall in three patients. During a mean follow-up period of 29.2+/-21.7 months (range 1-76 months) after hospital discharge, all patients were alive but one left VT case died of non-cardiovascular cause. We concluded that idiopathic left side and right side VTs have their distinct clinical, electrophysiologic and electropharmacological characteristics suggestive of different underlying mechanisms, and both have a benign prognosis. Furthermore, catheter ablation can be effective in eliminating idiopathic VT originating from the right ventricular outflow tract and left ventricle.
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Affiliation(s)
- C F Tsai
- Department of Medicine, National Yang-Ming University, School of Medicine, and Veterans General Hospital-Taipei, Taiwan, ROC
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50
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Abstract
Ablation has become an important and, in some cases, the first-line therapy for a number of tachyarrhythmias. The feasibility of treating arrhythmias with ablation was initially demonstrated with surgical ablation techniques. Recently, catheter ablation techniques have replaced the surgical approach in nearly all cases. Catheter ablation is highly effective for the Wolff-Parkinson-White syndrome, atrioventricular nodal reentry, and atrial ectopic tachycardia. It is effective for atrial flutter, although approximately one quarter of patients treated with catheter ablation continue to require therapy for concomitant atrial fibrillation. The surgical maze procedure has proved to be feasible for preventing atrial fibrillation. The risks and long-term efficacy of catheter ablation maze procedures for atrial fibrillation need to be defined. The efficacy of ablation for ventricular tachycardia varies with the type of tachycardia. Catheter ablation is very effective for the rare idiopathic ventricular tachycardias that occur in structurally normal hearts and for bundle-branch reentry ventricular tachycardia, which occurs most frequently in patients with dilated cardiomyopathy. When performed at an experienced center, surgical ablation is an excellent option for selected patients with ventricular tachycardia due to prior myocardial infarction who have a discrete aneurysm but otherwise well-preserved ventricular function. Catheter ablation shows promise for this arrhythmia, but it can be offered only to those patients who have relatively slow tachycardias that allow catheter mapping. Substantial advances in mapping and ablation technology will continue to occur, allowing nonpharmacologic control of cardiac arrhythmias to be achieved in an ever greater number of patients.
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Affiliation(s)
- W G Stevenson
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA
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