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1
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Wong CX, Nogami A, Hsia HH, Higuchi S, Scheinman MM. Fascicular Ventricular Tachycardias: Potential Role of the Septal Fascicle. JACC Clin Electrophysiol 2023; 9:1604-1620. [PMID: 37256250 DOI: 10.1016/j.jacep.2023.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 03/31/2023] [Accepted: 05/01/2023] [Indexed: 06/01/2023]
Abstract
Ventricular tachycardias involving the fascicular system are amongst the most challenging and intriguing arrhythmias for cardiac electrophysiologists. Although some of the more common forms have been recognized clinically for decades, other variants continue to be characterized. Moreover, considerable uncertainty persists to date with regards to the mechanisms underpinning these arrhythmias. In this state-of-the-art review, we discuss the seminal historical and contemporary observations that have collectively advanced our understanding of fascicular ventricular tachycardias. From this base, we canvas the basic and clinical evidence supporting a potential role for the septal fascicular network and propose a new schema hypothesizing involvement of this fascicle. Although we focus primarily on the most common left posterior fascicular ventricular tachycardia, our discussion and proposal have mechanistic and therapeutic implications for the spectrum of fascicular arrhythmias.
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Affiliation(s)
- Christopher X Wong
- Department of Electrophysiology, Division of Cardiology, University of California-San Francisco, San Francisco, California, USA. https://twitter.com/WongChrisX
| | - Akihiko Nogami
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan. https://twitter.com/AkihikoNogami
| | - Henry H Hsia
- Department of Electrophysiology, Division of Cardiology, University of California-San Francisco, San Francisco, California, USA. https://twitter.com/HHsiaMD
| | - Satoshi Higuchi
- Department of Electrophysiology, Division of Cardiology, University of California-San Francisco, San Francisco, California, USA. https://twitter.com/satoshihgc
| | - Melvin M Scheinman
- Department of Electrophysiology, Division of Cardiology, University of California-San Francisco, San Francisco, California, USA.
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2
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Xiong Y, Zhu H. Electrocardiographic characteristics of idiopathic ventricular arrhythmias based on anatomy. Ann Noninvasive Electrocardiol 2020; 25:e12782. [PMID: 32592448 PMCID: PMC7679832 DOI: 10.1111/anec.12782] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/02/2020] [Accepted: 05/26/2020] [Indexed: 12/26/2022] Open
Abstract
Idiopathic ventricular arrhythmia (IVA) is a term used to describe a spectrum of ventricular arrhythmia without structural heart disease (SHD). IVAs contain premature ventricular contractions (PVCs), nonsustained monomorphic ventricular tachycardia (VT), and sustained VT. Electrocardiography is a fundamental and important tool to diagnose and localize IVAs. More detailed, IVAs originating from different origins exhibit characterized ECGs due to their specific anatomic backgrounds. As catheter ablation becomes widely used to eliminate these arrhythmias, its high success rate is based on accurate localization of their origins. Therefore, these ECG characteristics show great importance for precise localization of their origins and subsequently successful ablation. This review aims to sum up ECG characteristics of IVAs based on anatomy and give brief introduction of mechanisms and treatment of IVAs.
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Affiliation(s)
- Yulong Xiong
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Hongling Zhu
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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3
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2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Heart Rhythm 2018; 15:e73-e189. [DOI: 10.1016/j.hrthm.2017.10.036] [Citation(s) in RCA: 177] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Indexed: 02/07/2023]
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4
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Al-Khatib SM, Stevenson WG, Ackerman MJ, Bryant WJ, Callans DJ, Curtis AB, Deal BJ, Dickfeld T, Field ME, Fonarow GC, Gillis AM, Granger CB, Hammill SC, Hlatky MA, Joglar JA, Kay GN, Matlock DD, Myerburg RJ, Page RL. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation 2018; 138:e272-e391. [PMID: 29084731 DOI: 10.1161/cir.0000000000000549] [Citation(s) in RCA: 249] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
| | - William G Stevenson
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Michael J Ackerman
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - William J Bryant
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - David J Callans
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Anne B Curtis
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Barbara J Deal
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Timm Dickfeld
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Michael E Field
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Gregg C Fonarow
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Anne M Gillis
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Christopher B Granger
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Stephen C Hammill
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Mark A Hlatky
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - José A Joglar
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - G Neal Kay
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Daniel D Matlock
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Robert J Myerburg
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Richard L Page
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
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5
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Al-Khatib SM, Stevenson WG, Ackerman MJ, Bryant WJ, Callans DJ, Curtis AB, Deal BJ, Dickfeld T, Field ME, Fonarow GC, Gillis AM, Granger CB, Hammill SC, Hlatky MA, Joglar JA, Kay GN, Matlock DD, Myerburg RJ, Page RL. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation 2018; 138:e210-e271. [PMID: 29084733 DOI: 10.1161/cir.0000000000000548] [Citation(s) in RCA: 149] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
| | - William G Stevenson
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Michael J Ackerman
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - William J Bryant
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - David J Callans
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Anne B Curtis
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Barbara J Deal
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Timm Dickfeld
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Michael E Field
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Gregg C Fonarow
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Anne M Gillis
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Christopher B Granger
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Stephen C Hammill
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Mark A Hlatky
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - José A Joglar
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - G Neal Kay
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Daniel D Matlock
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Robert J Myerburg
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Richard L Page
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
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6
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Al-Khatib SM, Stevenson WG, Ackerman MJ, Bryant WJ, Callans DJ, Curtis AB, Deal BJ, Dickfeld T, Field ME, Fonarow GC, Gillis AM, Granger CB, Hammill SC, Hlatky MA, Joglar JA, Kay GN, Matlock DD, Myerburg RJ, Page RL. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2018; 72:e91-e220. [PMID: 29097296 DOI: 10.1016/j.jacc.2017.10.054] [Citation(s) in RCA: 683] [Impact Index Per Article: 113.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Kahr PC, Wolber T, Saguner AM, Brunckhorst CB. [CME ECG 61/Answer: Management of Premature Ventricular Contractions]. PRAXIS 2018; 107:854-862. [PMID: 30043708 DOI: 10.1024/1661-8157/a003019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Peter C Kahr
- 1 Klinik für Kardiolgie, Unversitäres Herzzentrum, Universitätsspital Zürich
- 2 Klinik und Poliklinik für Innere Medizin, Universitätsspital Zürich
| | - Thomas Wolber
- 1 Klinik für Kardiolgie, Unversitäres Herzzentrum, Universitätsspital Zürich
| | - Ardan M Saguner
- 1 Klinik für Kardiolgie, Unversitäres Herzzentrum, Universitätsspital Zürich
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8
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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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9
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Al-Khatib SM, Stevenson WG, Ackerman MJ, Bryant WJ, Callans DJ, Curtis AB, Deal BJ, Dickfeld T, Field ME, Fonarow GC, Gillis AM, Granger CB, Hammill SC, Hlatky MA, Joglar JA, Kay GN, Matlock DD, Myerburg RJ, Page RL. 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: Executive summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Heart Rhythm 2017; 15:e190-e252. [PMID: 29097320 DOI: 10.1016/j.hrthm.2017.10.035] [Citation(s) in RCA: 381] [Impact Index Per Article: 54.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Indexed: 12/23/2022]
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10
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Al-Khatib SM, Stevenson WG, Ackerman MJ, Bryant WJ, Callans DJ, Curtis AB, Deal BJ, Dickfeld T, Field ME, Fonarow GC, Gillis AM, Granger CB, Hammill SC, Hlatky MA, Joglar JA, Kay GN, Matlock DD, Myerburg RJ, Page RL. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2017; 72:1677-1749. [PMID: 29097294 DOI: 10.1016/j.jacc.2017.10.053] [Citation(s) in RCA: 249] [Impact Index Per Article: 35.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Luo B, Zhou G, Guo X, Liu X, Yang J, Sun Q, Ma J, Zhang S. Long-term outcome of catheter ablation for left posterior fascicular ventricular tachycardia with the development of left posterior fascicular block and characteristics of repeat procedures. Int J Cardiol 2017; 236:203-208. [DOI: 10.1016/j.ijcard.2017.01.152] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 01/31/2017] [Indexed: 11/16/2022]
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12
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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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Kinjo T, Sasaki S, Kimura M, Owada S, Horiuchi D, Sasaki K, Itoh T, Ishida Y, Shoji Y, Nishizaki K, Tsushima Y, Tomita H, Okumura K. Long Postpacing Interval After Entrainment of Tachycardia Including a Slow Conduction Zone Within the Circuit. J Cardiovasc Electrophysiol 2016; 27:923-9. [PMID: 27196507 DOI: 10.1111/jce.13014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 05/08/2016] [Accepted: 05/11/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUNDS Postpacing interval (PPI) measured after entrainment pacing describes the distance between pacing site and reentrant circuit. However, the influential features to PPI remain to be elucidated. METHODS AND RESULTS This study included 22 cases with slow/fast atrioventricular (AV) nodal reentrant tachycardia (AVNRT), 14 orthodromic AV reciprocating tachycardia (AVRT) using an accessary pathway, 22 typical atrial flutter (AFL), and 18 other macroreentrant atrial tachycardia (atypical AFL). Rapid pacing at a pacing cycle length (PCL) 5% shorter than tachycardia cycle length (TCL) was done from a site on or close to the reentry circuit. Pacing sites included the coronary sinus ostium in AVNRT, earliest atrial activation site in AVRT, and cavotricuspid isthmus in typical AFL. In atypical AFL, tachycardia circuit was determined on the basis of CARTO mapping, and then the pacing site was. TCL was significantly longer in AVNRT and AVRT than in typical AFL and atypical AFL (both P < 0.05). PCL minus TCL value was similar among the 4 groups. PPI minus TCL value (milliseconds) was significantly longer in AVNRT (median, 40 [IQR, 29-60.8]) and AVRT (34 [20-47]) than in typical AFL (0 [0-4]) and atypical AFL (3.5 [0-8]) (both P < 0.05). Furthermore, PPI minus TCL was prolonged with shortening of PCL in AVNRT and AVRT (both P < 0.05), whereas it was unchanged in typical AFL (P = 0.50). CONCLUSION PPI after concealed entrainment is prolonged compared with TCL when the reentry circuit involves a slow conduction zone with a decremental conduction property such as the AV node.
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Affiliation(s)
- Takahiko Kinjo
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shingo Sasaki
- Department of Advanced Management of Cardiac Arrhythmias, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Masaomi Kimura
- Department of Hypertension and Stroke Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shingen Owada
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Daisuke Horiuchi
- Department of Advanced Management of Cardiac Arrhythmias, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Kenichi Sasaki
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Taihei Itoh
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuji Ishida
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yoshihiro Shoji
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Kimitaka Nishizaki
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuichi Tsushima
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hirofumi Tomita
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.,Department of Hypertension and Stroke Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Ken Okumura
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.,Department of Advanced Management of Cardiac Arrhythmias, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.,Department of Hypertension and Stroke Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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Catheter ablation of idiopathic fascicular ventricular tachycardia: The role of isolated diastolic potentials during mapping in sinus rhythm. Int J Cardiol 2015; 201:212-4. [DOI: 10.1016/j.ijcard.2015.08.008] [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: 07/15/2015] [Accepted: 08/01/2015] [Indexed: 11/23/2022]
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Talib AK, Nogami A, Nishiuchi S, Kowase S, Kurosaki K, Matsui Y, Kawada S, Watanabe A, Nozoe M, Uno K, Yagishita A, Yamauchi Y, Takahashi Y, Kuwahara T, Takahashi A, Kumagai K, Naito S, Asakawa T, Sekiguchi Y, Aonuma K. Verapamil-Sensitive Upper Septal Idiopathic Left Ventricular Tachycardia: Prevalence, Mechanism, and Electrophysiological Characteristics. JACC Clin Electrophysiol 2015; 1:369-380. [PMID: 29759464 DOI: 10.1016/j.jacep.2015.05.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 05/11/2015] [Accepted: 05/21/2015] [Indexed: 01/27/2023]
Abstract
OBJECTIVES This study sought to demonstrate the prevalence, mechanism, and electrocardiographic and electrophysiological characteristics of upper septal idiopathic left fascicular ventricular tachycardia (US-ILVT). BACKGROUND ILVT is classified into left anterior and posterior types with no clear data about US-ILVT. METHODS Among 193 ILVT patients, we identified 12 patients (6.2%; age 41 ± 22 years, 7 men) with US-ILVT. RESULTS Of 12 patients with US-ILVT, 6 patients (50%) had previous history of radiofrequency catheter ablation for common ILVT. Sustained VT (cycle length: 349 ± 53 ms) was seen in all patients with a QRS interval slightly wider (104 ± 18 ms) than that during sinus rhythm (90 ± 19 ms). The VT exhibited an identical QRS configuration as sinus rhythm in 6 (50%) and incomplete right bundle branch block configuration in another 6. His-ventricular interval during VT was always shorter than that during sinus rhythm (27 ± 5 ms vs. 47 ± 10 ms). Purkinje potentials were activated in a reverse direction to that of common ILVT; namely, the diastolic potential (P1) was activated retrogradely but the pre-systolic potential (P2) was activated antegradely. At the left upper-middle ventricular septum, P1 potential was recorded during VT, preceding the QRS by 54 ± 20 ms. Radiofrequency catheter ablation at that site eliminated the VT with no recurrence during a 58 ± 35 months of follow-up. CONCLUSIONS US-ILVT is an identifiable VT that shares common criteria with ILVT and has a narrow QRS interval. Some US-ILVT cases appeared after common ILVT ablation. It is a reverse type of common ILVT (orthodromic form) with baseline morphological abnormalities that might provide a potential substrate for such VT.
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Affiliation(s)
- Ahmed Karim Talib
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Akihiko Nogami
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
| | - Suguru Nishiuchi
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan
| | - Shinya Kowase
- Department of Heart Rhythm Management, Yokohama Rosai Hospital, Yokohama, Japan
| | - Kenji Kurosaki
- Department of Heart Rhythm Management, Yokohama Rosai Hospital, Yokohama, Japan
| | - Yumie Matsui
- Department of Cardiology, Saiseikai Izuo Hospital, Osaka, Japan
| | - Satoshi Kawada
- Division of Cardiology, Fukuyama City Hospital, Fukuyama, Japan
| | | | - Masatsugu Nozoe
- Division of Cardiology, Cardiovascular and Aortic Center, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
| | - Kikuya Uno
- Sapporo Heart Center, Sapporo Cardiovascular Clinic, Sapporo, Japan
| | | | - Yasuteru Yamauchi
- Department of Cardiology, Musashino Red Cross Hospital, Tokyo, Japan
| | | | - Taishi Kuwahara
- Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | | | - Koji Kumagai
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan
| | - Shigeto Naito
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan
| | - Tetsuya Asakawa
- Cardiology Division, Yamanashi Kosei Hospital, Yamanashi, Japan
| | - Yukio Sekiguchi
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kazutaka Aonuma
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Liu XY, Wei W, Chu JM, Wang LX, Zhao YJ, Wang J, Pu JL, Zhang S. Variations of electroanatomic substrates and markers of successful ablation in idiopathic left ventricular tachycardia. J Cardiovasc Med (Hagerstown) 2014; 15:659-67. [DOI: 10.2459/jcm.0b013e328365c174] [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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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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SUNG RAPHAELK, KIM ALBERTM, TSENG ZIANH, HAN FREDERICK, INADA KEIICHI, TEDROW USHAB, VISWANATHAN MOHANN, BADHWAR NITISH, VAROSY PAULD, TANEL RONN, OLGIN JEFFREYE, STEPHENSON WILLIAMG, SCHEINMAN MELVIN. Diagnosis and Ablation of Multiform Fascicular Tachycardia. J Cardiovasc Electrophysiol 2012; 24:297-304. [DOI: 10.1111/jce.12020] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Chu J, Sun Y, Zhao Y, Wei W, Wang J, Liu X, Jia Y, Mao K, Pu J, Zhang S. Identification of the slow conduction zone in a macroreentry circuit of verapamil-sensitive idiopathic left ventricular tachycardia using electroanatomic mapping. J Cardiovasc Electrophysiol 2012; 23:840-5. [PMID: 22452322 DOI: 10.1111/j.1540-8167.2012.02312.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although idiopathic left ventricular tachycardia (ILVT) has been shown to possess a slow conduction zone (SCZ), the details of the electrophysiological and anatomic aspects are still not well understood. OBJECTIVE We hypothesized that the SCZ can be identified using a 3-dimensional electroanatomic (EA) mapping system. METHODS Ten patients with ILVT were mapped using a 3-dimensional electroanatomic (EA) mapping system. After a 3-dimensional endocardial geometry of the left ventricular was created, the conduction system with left Purkinje potential (PP) and the SCZ with diastolic potential (DP) in LV were mapped during sinus rhythm (SR) and ventricular tachycardia (VT) and were tagged as special landmarks in the geometry. The electrophysiological and anatomic aspects of it were investigated. RESULTS EA mapping during SR and VT was successfully performed in 7 patients, during VT in 3 patients. The SCZ with DPs located at the inferoposterior septum was found in 7 patients during SR and all patients during VT. The length of the SCZ was 25.2 ± 2.3 mm with conduction velocity 0.08 ± 0.01 m/s. No differences in these parameters were found between patients during SR and VT (P > 0.05). An area with PP was found within the posterior septum. A crossover junction area with DP and PP was found in 7 patients during SR and VT. This area with DP and PP during SR coincided or were in proximity to such area during VT and radiofrequency ablation targeting the site within the area abolished VT in all patients. CONCLUSION The ILVT substrate within the junction area of the SCZ and the posterior fascicular can be identified and can be used to guide the ablation of ILVT.
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Affiliation(s)
- Jianmin Chu
- Clinical EP Laboratory and Arrhythmia Service Center of Fuwai Heart Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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Park J, Kim YH, Hwang C, Pak HN. Electroanatomical characteristics of idiopathic left ventricular tachycardia and optimal ablation target during sinus rhythm: significance of preferential conduction through Purkinje fibers. Yonsei Med J 2012; 53:279-88. [PMID: 22318814 PMCID: PMC3282975 DOI: 10.3349/ymj.2012.53.2.279] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE We hypothesized that Purkinje potential and their preferential conduction to the left ventricle (LV) posteroseptum during sinus rhythm (SR) are part of reentrant circuits of idiopathic left ventricular tachycardia (ILVT) and reentry anchors to papillary muscle. MATERIALS AND METHODS In 14 patients with ILVT (11 men, mean age 31.5±11.1 years), we compared Purkinje potential and preferential conduction during SR with VT by non-contact mapping (NCM). If clear Purkinje potential(SR) was observed in the LV posteroseptum and the earliest activation site (EA) of preferential conduction at SR (EA(SR)) was well matched with that of VT (EA(VT)), EA(SR) was targeted for radiofrequency catheter ablation (RFCA). Also, the anatomical locations of successful ablation sites were evaluated by echocardiography in five additional patients. RESULTS 1) All induced VTs exhibited clear Purkinje potential(VT) and preferential conduction in the LV posteroseptum. The Purkinje potential(VT) and EA(VT) was within 5.8±8.2 mm of EA(SR). However, the breakout sites of VT were separated by 30.2±12.6 mm from EA(VT) to the apical side. 2) Purkinje potential(SR) demonstrated a reversed polarity to Purkinje potential(VT), and the interval of Purkinje potential(SR)-QRS was longer than the interval of Purkinje potential(VT)-QRS (p<0.02) 3) RFCA targeting EA(SR) eliminated VT in all patients without recurrence within 23.3±7.5 months, and the successful ablation site was discovered at the base of papillary muscle in the five additional (100%) patients. CONCLUSION NCM-guided localization of EA(SR) with Purkinje potential(SR) matches well with EA(VT) with Purkinje potential(VT) and provides an effective target for RFCA, potentially at the base of papillary muscle in patients with ILVT.
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Affiliation(s)
- Junbeom Park
- Department of Cardiology, Yonsei University Health System, Seoul, Korea
| | | | - Chun Hwang
- Utah Valley Regional Medical Center, Provo, UT and Krannert Heart Institute, Indiana University, Indianapolis, IN, USA
| | - Hui-Nam Pak
- Department of Cardiology, Yonsei University Health System, Seoul, Korea
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Hu JQ, Ma J, Yang Q, Liao ZL, Hou Y, Zhang S. The characteristics of verapamil-sensitive idiopathic left ventricular tachycardia combined with a left accessory pathway and the effect of radiofrequency catheter ablation. Europace 2011; 14:703-8. [PMID: 22016304 DOI: 10.1093/europace/eur330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS Verapamil-sensitive idiopathic left ventricular tachycardia (ILVT) combined with a left accessory pathway (AP) is a relatively rare condition. This study examines the characteristics of patients with this condition and the effect of radiofrequency catheter ablation (RFCA). METHODS AND RESULTS Catheter ablation was performed on 140 ILVT patients at a single centre from January 2004 to December 2009. A concealed left AP was found in seven patients (5%), all of whom were male, with an average age of 21 ± 9 years. Sustained ILVT and orthodromic atrioventricular reentrant tachycardia (AVRT) were induced in all seven patients. Retrograde activation through a bystander AP occurred concomitantly with ILVT, with an average tachycardia length of 346 ± 29 ms (range 310-400 ms). The location of the APs in four patients was left posterior, two of which showed a slow and decremental property, while in three it was left lateral. Ablation via a retrograde transaortic approach was performed in the seven patients. The left AP was ablated first in six patients, but ILVT was no longer induced in one and became non-sustained in another. In the seventh patient, ILVT was ablated first and this proved successful. CONCLUSIONS Among patients with IVLT, 5% had a concomitant left AP, most of who were young men. The location of the left AP was mainly posterior and lateral, with 30% showing a slow and decremental property. Idiopathic left ventricular tachycardia and AP should be ablated simultaneously.
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Affiliation(s)
- Ji-qiang Hu
- Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, 167 Beilishi Road, Beijing 100037, China
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Cleary-Goldman J, Salva CR, Infeld JI, Robinson JN. Verapamil-sensitive idiopathic left ventricular tachycardia in pregnancy. J Matern Fetal Neonatal Med 2009; 14:132-5. [PMID: 14629096 DOI: 10.1080/jmf.14.2.132.135] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Verapamil-sensitive idiopathic left ventricular tachycardia is a rare diagnosis. A 31-year-old multiparous woman presented with shortness of breath, palpitations and new-onset, wide complex tachycardia at approximately 28 weeks' gestation. Multiple antiarrhythmic agents were administered without resolution of the arrhythmia. Verapamil-sensitive idiopathic left ventricular tachycardia was diagnosed on the basis of a fusion beat with a right bundle branch pattern, a pathognomonic finding, which was noted on an electrocardiogram. Verapamil resulted in conversion to normal sinus rhythm. The patient delivered at term uneventfully. To our knowledge, this is the first description of verapamil-sensitive idiopathic left ventricular tachycardia in pregnancy. The case illustrates that the origin of wide complex tachyarrhythmias should be identified to provide the proper treatment expeditiously.
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Affiliation(s)
- J Cleary-Goldman
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Columbia University, Presbyterian Medical Center, New York, New York 10032, USA
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Yao SY, Chu JM, Fang PH, Zhang KJ, Ma J, Zhang S. The morphology changes in limb leads after ablation of verapamil-sensitive idiopathic left ventricular tachycardia and their correlation with recurrence. J Cardiovasc Electrophysiol 2007; 19:238-41. [PMID: 18031513 DOI: 10.1111/j.1540-8167.2007.01023.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study was designed to explore the morphology changes in limb leads of ECGs after successful ablation of verapamil sensitive idiopathic left ventricular tachycardia (ILVT) and their correlation with tachycardia recurrence. METHODS Between January 2001 and December 2006, 116 patients who underwent successful ablation of ILVT were included in the study. Twelve-lead surface ECG recordings during sinus rhythm were obtained in all patients before and after ablation to compare morphology changes in limb leads. RESULTS The ECG morphology changes after ablation were divided into two categories: one with new or deepening Q wave in inferior leads and/or disappearance of Q wave in leads I and aVL, and the other without change. The changes in any Lead II, III, or aVF after ablation occurred significantly more in patients without recurrence of ventricular tachycardia (VT) (P < 0.0001, 0.002, and 0.0001, respectively). The patients with recurrence of VT tended to have no ECG changes, compared with those without recurrence of VT (P = 0.009). The sensitivity of leads II, III, and aVF changes in predicting nonrecurrence VT were 66.7%, 78.7%, and 79.6%, specificity were 100%, 75%, and 87.5%, and nonrecurrence predictive value of 100%, 97.7%, and 98.9%, respectively. When inferior leads changes were combined, they could predict all nonrecurrence patients with 100% specificity. CONCLUSIONS Successful radiofrequency ablation of ILVT could result in morphology changes in limb leads of ECG, especially in inferior leads. The combined changes in inferior leads can be used as an effective endpoint in ablation of this ILVT.
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Affiliation(s)
- Shu-Yuan Yao
- Center of Arrhythmia, Fuwai Cardiovascular Hospital, Peking Union Medical College, Beijing
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Nagai T, Suyama K, Shimizu W, Noda T, Satomi K, Kurita T, Aihara N, Kamakura S. Pilsicainide-Induced Verapamil Sensitive Idiopathic Left Ventricular Tachycardia. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2006; 29:549-52. [PMID: 16689855 DOI: 10.1111/j.1540-8159.2006.00393.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A 20-year-old man was admitted to our hospital for treatment of verapamil sensitive idiopathic left ventricular tachycardia (ILVT). During the electrophysiologic study (EPS), no sustained ventricular tachycardia (VT) could be induced both at baseline and after infusion of isoproterenol. However, sustained clinical VT could be easily induced with single ventricular extrastimulation following intravenous administration of pilsicainide, a class Ic sodium channel blocker. The arrhythmia was ablated with radiofrequency catheter ablation.
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Affiliation(s)
- Takayuki Nagai
- Division of Cardiology, Department of Internal Medicine, National Cardiovascular Center, Suita, Osaka, Japan
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Tsou CH, Chiang CE, Kao T, Jawan B, Luk HN. Atropine-triggered idiopathic ventricular tachycardia in an asymptomatic pediatric patient. Can J Anaesth 2004; 51:856-7. [PMID: 15470186 DOI: 10.1007/bf03018472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Kaneko Y, Taniguchi Y, Nakajima T, Manita M, Ito T, Akiyama M, Kurabayashi M. Myocardial Bundles with Slow Conduction Properties are Present on the Left Interventricular Septal Surface of Normal Human Hearts. J Cardiovasc Electrophysiol 2004; 15:1010-8. [PMID: 15363072 DOI: 10.1046/j.1540-8167.2004.04059.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The aim of this study was to examine the electrophysiologic characteristics of the normal left interventricular septum (LIVS). METHODS AND RESULTS We explored the LIVS in search of endocardial potentials following ventricular electrograms during sinus rhythm in 28 patients without structural heart disease. In all patients, low-frequency (mean amplitude: 0.81 +/- 0.33 mV) systolic potentials (LA1) were detected in a basal-to-apical activation sequence (earliest to latest QRS-LA1 interval: 93.3 +/- 10.8 ms to 127.1 +/- 16.6 ms). Programmed stimulation demonstrated decremental conduction properties, and the effective refractory period of the tissue between the ventricular electrogram and LA1 at baseline (376.7 +/- 48.8 ms) was significantly prolonged by disopyramide (421.3 +/- 54.1 ms, P < 0.05 vs baseline). In 21 patients (75%), diastolic potentials (LA2) morphologically similar to LA1 (mean amplitude: 0.52 +/- 0.17 mV) were detected in an apical-to-basal activation sequence (earliest to latest QRS-LA2 interval: 368.9 +/- 32.4 ms to 440.7 +/- 45.8 ms). Para-Hisian pacing with capture of the His bundle showed shorter S-LA1 and S-LA2 intervals compared to the beats without His-bundle capture but with ventricular capture (156.3 +/- 11.2 ms vs 183.2 +/- 12.3 ms, and 385.7 +/- 21.6 ms vs 397.4 +/- 23.4 ms, respectively, P < 0.0001). At the same rate, the LA1-LA2 interval was significantly shorter during right ventricular apical than atrial overdrive pacing (220.4 +/- 23.1 ms vs 261.4 +/- 30.7 ms, P < 0.0001). CONCLUSION Unique myocardial bundles with slow conduction properties and various electrical connections with the specialized conduction system may exist in the LIVS of normal human hearts.
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Affiliation(s)
- Yoshiaki Kaneko
- Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi, Japan.
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Affiliation(s)
- Mark E Josephson
- Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
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Josephson ME. Electrophysiology of Ventricular Tachycardia:. A Historical Perspective. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2003; 26:2052-67. [PMID: 14516353 DOI: 10.1046/j.1460-9592.2003.00320.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Mark E Josephson
- Department of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA.
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Abstract
This review focuses on four distinct syndromes of ventricular tachycardia that occur in the structurally normal heart. Recent advances in the fields of molecular biology and genetics, along with intracardiac mapping techniques, have led to a greater understanding of the underlying mechanisms of and therapeutic options for these syndromes. The cyclic AMP-mediated triggered activity tachycardias, including exercise-induced right ventricular outflow track tachycardia and repetitive monomorphic ventricular tachycardia, are the most common of these syndromes. Idiopathic left ventricular tachycardia, for which there is significant evidence for re-entry within the Purkinje network, is largely curable with catheter ablation. The long QT syndrome comprises a heterogeneous group of ion channel defects leading to prolongation of myocyte repolarization and Torsade de Pointes ventricular tachycardia. Brugada syndrome, a familial disorder of transmembrane ion transport, is felt to be the result of a group of sodium channel defects leading to characteristic electrocardiographic abnormalities, and syncope and sudden death. Primary focus is given to recent advances in our understanding of the underlying mechanism and current therapeutic approaches.
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Affiliation(s)
- T Scott Wall
- University of Utah Medical Center, Division of Cardiology, 50 North Medical Drive, Salt Lake City, UT 84132, USA
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Ouyang F, Cappato R, Ernst S, Goya M, Volkmer M, Hebe J, Antz M, Vogtmann T, Schaumann A, Fotuhi P, Hoffmann-Riem M, Kuck KH. Electroanatomic substrate of idiopathic left ventricular tachycardia: unidirectional block and macroreentry within the purkinje network. Circulation 2002; 105:462-9. [PMID: 11815429 DOI: 10.1161/hc0402.102663] [Citation(s) in RCA: 112] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND An abnormal potential (retroPP) from the left posterior Purkinje network has been demonstrated during sinus rhythm (SR) in some patients with idiopathic left ventricular tachycardia (ILVT). We hypothesized that this potential can specifically be identified and be a critical substrate for ILVT. METHODS AND RESULTS In 9 patients with ILVT and 6 control patients who underwent mapping of the left ventricle during SR using 3-dimensional electroanatomic mapping, an area with retroPP was found within the posterior Purkinje fiber network only in patients with ILVT. The earliest and latest retroPP was 185.4+/-57.4 and 465.2+/-37.3 ms after Purkinje potential; in the other patient with ILVT, an entire left ventricle mapping demonstrated a slow conduction area and passive retrograde activation along the posterior fascicle during ILVT. ILVT was noninducible in 3 patients after SR mapping. Diastolic potentials critical for ILVT during ILVT coincided with the earliest retroPP during SR in 7 patients. Mechanical termination of ILVT occurred in 5 patients. A single radiofrequency pulse was applied at the site with mechanical translation in 5 patients and the site with diastolic potential in 2 patients, and 3 radiofrequency pulses were delivered to the site with the earliest retroPP in the other 3 patients without inducible ILVT after SR mapping. No ILVT was inducible during control stimulation, and none recurred during follow-up of 9.1+/-5.1 months. CONCLUSION In patients with ILVT, abnormal retroPP within the posterior Purkinje fiber network is a common finding. The earliest retroPP critical for ILVT substrate can be used for guiding successful ablation.
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Affiliation(s)
- Feifan Ouyang
- Zweite Medizinische Abteilung, Allgemeines Krankenhaus St Georg, Hamburg, Germany.
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