1
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Zaccaro L, Avondo S, Albani S, Scacciatella P. A rare case of upper septal fascicular ventricular tachycardia presented in a case report. Ann Cardiol Angeiol (Paris) 2024; 73:101738. [PMID: 38354636 DOI: 10.1016/j.ancard.2024.101738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 12/12/2023] [Accepted: 01/22/2024] [Indexed: 02/16/2024]
Abstract
CASE SUMMARY A 71-year-old presented at the outpatient clinic with palpitations and NYHA II functional class. 12-lead ECG exhibited Upper septal idiopathic left ventricular tachycardia (US-ILVT). Ventricular tachycardia (VT) was interrupted with Verapamil administration, no further recurrences were documented after beta-blockers therapy was started. No coronary artery stenosis were detected. The US-ILVT was successfully treated by ablating the proximal site of the left anterior fascicle (LAF), where diastolic potential (P1) and pre-systolic potential (P2) with inverted sequence were detected during the electrophysiology study (EP) study. Cardiac magnetic resonance imaging (CMR) was performed with demonstration of intramyocardial late gadolinium enhancement (LGE) at the level of middle-basal portions of interventricular septum and basal portion of infero-lateral wall and no edema detection. A single catheter implantable cardioverter defibrillator (ICD) was implanted as secondary prevention. VT has never recurred during 3 months of follow-up with remote control of ICD. DISCUSSION To the best of our knowledge, this is the first report in which US-ILVT was associated with ventricular septal LGE, suggestive of previous myocarditis, as substrate of re-entrant circuit. Scar-related ventricular tachycardia circuit is also suggested by the evidence of a premature ventricular complex (PVC) as trigger of recurrent VT in our case.
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Affiliation(s)
- Lorenzo Zaccaro
- Division of Cardiology, Umberto Parini Regional Hospital, Aosta, Italy; Division of Cardiology, Department of Medical Science, University of Turin, Turin, Italy
| | - Stefano Avondo
- Division of Cardiology, Umberto Parini Regional Hospital, Aosta, Italy; Division of Cardiology, Department of Medical Science, University of Turin, Turin, Italy
| | - Stefano Albani
- Division of Cardiology, Umberto Parini Regional Hospital, Aosta, Italy.
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2
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Pafford C, Kean AC, Showalter C. Idiopathic fascicular ventricular tachycardia in children: a challenging arrythmia worth recognizing. CAN J EMERG MED 2023; 25:845-847. [PMID: 37491665 DOI: 10.1007/s43678-023-00558-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/03/2023] [Indexed: 07/27/2023]
Affiliation(s)
- Carl Pafford
- Department of Emergency Medicine, Indiana University School of Medicine, 720 Eskenazi Ave, Fifth Third Bank Building 3rd Floor, Indianapolis, IN, 46202, USA.
| | - Adam C Kean
- Department of Pediatrics, Division of Cardiology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Cory Showalter
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
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3
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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: 2] [Impact Index Per Article: 2.0] [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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4
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Nogami A, Phanthawimol W, Haruna T. Catheter Ablation for Ventricular Tachycardia Involving the His-Purkinje System: Fascicular and Bundle Branch Reentrant Ventricular Tachycardia. Card Electrophysiol Clin 2022; 14:633-656. [PMID: 36396182 DOI: 10.1016/j.ccep.2022.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The Purkinje system has been found to mediate several monomorphic ventricular tachycardias (VTs). These include fascicular VTs and bundle branch reentrant (BBR) VTs. Previous studies have revealed that VTs involving the His-Purkinje system are composed of multiple discrete subtypes that are best differentiated by their mechanism, drug effect, VT morphology, and successful ablation site. Recognition of the heterogeneity of these VTs and their unique characteristics should facilitate the appropriate diagnosis and therapy and help guide catheter ablation therapy. In this article, we focus on the latest updates of the mechanisms underlying left ventricle fascicular VTs and BBR-VTs as well as the latest catheter ablation techniques.
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Affiliation(s)
- Akihiko Nogami
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan.
| | - Wipat Phanthawimol
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Tetsuya Haruna
- Department of Cardiology, Kitano Hospital, 2-4-20 Ohgimachi, Kita-ku, Osaka 530-8480, Japan
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5
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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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6
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Viswanathan MN, Julie He B, Sung R, Hoffmayer KS, Badhwar N, Lee A, Goldberger JJ, Hsia HH, Jackman WM, Scheinman MM. Importance of the Activation Sequence of the His or Right Bundle for Diagnosis of Complex Tachycardia Circuits. Circ Arrhythm Electrophysiol 2021; 14:e009194. [PMID: 34601885 DOI: 10.1161/circep.120.009194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this review, we emphasize the unique value of recording the activation sequence of the His bundle or right bundle branch (RB) for diagnoses of various supraventricular and fascicular tachycardias. A close analysis of the His to RB (H-RB) activation sequence can help differentiate various forms of supraventricular tachycardias, namely atrioventricular nodal reentry tachycardia from concealed nodofascicular tachycardia, a common clinical dilemma. Furthermore, bundle branch reentry tachycardia and fascicular tachycardias often are included in the differential diagnosis of supraventricular tachycardia with aberrancy, and the use of this technique can help the operator make the distinction between supraventricular tachycardias and these other forms of ventricular tachycardias using the His-Purkinje system. We show that this technique is enhanced by the use of multipolar catheters placed to span the proximal His to RB position to record the activation sequence between proximal His potential to the distal RB potential. This allows the operator to fully analyze the activation sequence in sinus rhythm as compared to that during tachycardia and may help target ablation of these arrhythmias. We argue that 3 patterns of H-RB activation are commonly identified-the anterograde H-RB pattern, the retrograde H-RB (right bundle to His bundle) pattern, and the chevron H-RB pattern (simultaneous proximal His and proximal RB activation)-and specific arrhythmias tend to be associated with specific H-RB activation sequences. We show that being able to record and categorize this H-RB relationship can be instrumental to the operator, along with standard pacing maneuvers, to make an arrhythmia diagnosis in complex tachycardia circuits. We highlight the importance of H-RB activation patterns in these complex tachycardias by means of case illustrations from our groups as well as from prior reports.
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Affiliation(s)
| | - Beixin Julie He
- University of California, San Francisco, CA (B.J.H., A.L., H.H.H., M.M.S.)
| | | | | | - Nitish Badhwar
- Stanford University School of Medicine, CA (M.N.V., N.B.)
| | - Adam Lee
- University of California, San Francisco, CA (B.J.H., A.L., H.H.H., M.M.S.)
| | | | - Henry H Hsia
- University of California, San Francisco, CA (B.J.H., A.L., H.H.H., M.M.S.)
| | - Warren M Jackman
- University of Oklahoma School of Medicine, Oklahoma City (W.M.J.)
| | - Melvin M Scheinman
- University of California, San Francisco, CA (B.J.H., A.L., H.H.H., M.M.S.)
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7
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Vigmond EJ, Bouyssier J, Bayer J, Haïssaguerre M, Ashikaga H. On the nature of delays allowing anatomical re-entry involving the Purkinje network: a simulation study. Europace 2021; 23:i71-i79. [PMID: 33463686 DOI: 10.1093/europace/euaa395] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 12/03/2020] [Indexed: 12/31/2022] Open
Abstract
AIMS Clinical observations suggest that the Purkinje network can be part of anatomical re-entry circuits in monomorphic or polymorphic ventricular arrhythmias. However, significant conduction delay is needed to support anatomical re-entry given the high conduction velocity within the Purkinje network. METHODS AND RESULTS We investigated, in computer models, whether damage rendering the Purkinje network as either an active lesion with slow conduction or a passive lesion with no excitable ionic channel, could explain clinical observations. Active lesions had compromised sodium current and a severe reduction in gap junction coupling, while passive lesions remained coupled by gap junctions, but modelled the membrane as a fixed resistance. Both types of tissue could provide significant delays of over 100 ms. Electrograms consistent with those obtained clinically were reproduced. However, passive tissue could not support re-entry as electrotonic coupling across the delay effectively increased the proximal refractory period to an extremely long interval. Active tissue, conversely, could robustly maintain re-entry. CONCLUSION Formation of anatomical re-entry using the Purkinje network is possible through highly reduced gap junctional coupling leading to slowed conduction.
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Affiliation(s)
- Edward J Vigmond
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac-Bordeaux, France.,Univ. Bordeaux, IMB, UMR 5251, F-33400 Talence, France
| | - Julien Bouyssier
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac-Bordeaux, France.,Univ. Bordeaux, IMB, UMR 5251, F-33400 Talence, France
| | - Jason Bayer
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac-Bordeaux, France.,Univ. Bordeaux, IMB, UMR 5251, F-33400 Talence, France
| | - Michel Haïssaguerre
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac-Bordeaux, France.,Univ. Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F-33000 Bordeaux, France.,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F-33600 Pessac, France
| | - Hiroshi Ashikaga
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac-Bordeaux, France.,Cardiac Arrhythmia Service, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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8
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Han J, Lee JZ, Padmanabhan D, Naksuk N, Asirvatham SJ, Munger TM, Killu AM, Madhavan M, Xiao P, Zheng LR, Cha YM. Catheter ablation of premature ventricular contractions originating from periprosthetic aortic valve regions. J Cardiovasc Electrophysiol 2020; 32:400-408. [PMID: 33305865 DOI: 10.1111/jce.14836] [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] [Received: 07/09/2020] [Revised: 10/29/2020] [Accepted: 11/30/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Little is known about the ablation outcomes of premature ventricular contractions (PVCs) that originate from the periprosthetic aortic valve (PPAV) regions of patients with aortic valve replacement (AVR). METHODS AND RESULTS Our study had 11 patients who underwent catheter ablation for PVCs arising from the PPAV regions (bioprosthetic aortic valve, n = 5; mechanical aortic valve, n = 6). The PVC characteristics, procedure characteristics, and efficacy of ablation were compared with the control group (n = 33). At baseline, the PPAV group had a lower left ventricular ejection fraction (mean [SD], 41% [12%] vs. 51% [8%]; p = .002). The rate of acute ablation success was 90.9% in the PPAV group. Ablation sites were identified above the left coronary cusp (LCC) and right coronary cusp commissure (LRCC) in one PVC, below the prosthetic valve in eight PVCs (four below LCC and four below LRCC), and within the distal coronary sinus in two PVCs. The mean procedure time, fluoroscopy time, and radiation in the PPAV group were all significantly greater than those in the control group (all p < .05). However, the number of radiofrequency ablation energy deliveries was not different. The PPAV group had a long-term success rate compared with the control group (72.7% vs. 87.9%, p = .48) and an increase of left ventricular ejection fraction from 43% to 49% after successful PVC ablation at follow-up (p < .001). Echocardiography showed no significant change in valve regurgitation after ablation. No new atrioventricular block occurred. CONCLUSION PVCs arising from PPAV regions can be successfully ablated in patients with prior AVR, without damaging the prosthetic aortic valve and atrioventricular conduction.
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Affiliation(s)
- Jie Han
- Department of Cardiology and Atrial Fibrillation Center, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Justin Z Lee
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Deepak Padmanabhan
- Electrophysiology Unit, Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
| | - Niyada Naksuk
- Division of Cardiology, Department of Internal Medicine, University of Illinois, Chicago, Illinois, USA
| | - Samuel J Asirvatham
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
| | - Thomas M Munger
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ammar M Killu
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Malini Madhavan
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - PeiLin Xiao
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Liang-Rong Zheng
- Department of Cardiology and Atrial Fibrillation Center, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Yong-Mei Cha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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9
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Silva LTME, Vale PDD, Rocha JMD, Margalho CS, Maia HCDA. Belhassen Syndrome in Teenager Originating from Left Anterior Fascicle. JOURNAL OF CARDIAC ARRHYTHMIAS 2020. [DOI: 10.24207/jca.v33i4.3417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
A 16-year-old female patient was hospitalized due to narrow QRS tachycardia suggestive of fascicular ventricular tachycardia. Initially, the differential diagnosis with supraventricular tachycardia can be challenging. The tachyarrhythmia is well controlled with medication, but electrophysiological study and ablation may be necessary in patients who remain symptomatic.
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Affiliation(s)
| | - Paula Damasco do Vale
- Instituto Hospital de Base do Distrito Federal – Serviço de Eletrofisiologia – Brasília/DF – Brazil
| | - Jairo Macedo da Rocha
- Ritmocardio Serviço de Arritmia e Eletrofisiologia de Brasília – Brasília/DF – Brazil
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10
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Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Della Bella P, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Sáenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. Europace 2020; 21:1143-1144. [PMID: 31075787 DOI: 10.1093/europace/euz132] [Citation(s) in RCA: 232] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
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Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, California
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
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11
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Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Bella PD, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Saenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. J Interv Card Electrophysiol 2020; 59:145-298. [PMID: 31984466 PMCID: PMC7223859 DOI: 10.1007/s10840-019-00663-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
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Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, IN, USA
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, CA, USA
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
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12
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Kim Y, Chen S, Ernst S, Guzman CE, Han S, Kalarus Z, Labadet C, Lin Y, Lo L, Nogami A, Saad EB, Sapp J, Sticherling C, Tilz R, Tung R, Kim YG, Stiles MK. 2019 APHRS expert consensus statement on three-dimensional mapping systems for tachycardia developed in collaboration with HRS, EHRA, and LAHRS. J Arrhythm 2020; 36:215-270. [PMID: 32256872 PMCID: PMC7132207 DOI: 10.1002/joa3.12308] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 01/20/2020] [Indexed: 12/24/2022] Open
Affiliation(s)
- Young‐Hoon Kim
- Department of Internal MedicineArrhythmia CenterKorea University Medicine Anam HospitalSeoulRepublic of Korea
| | - Shih‐Ann Chen
- Division of CardiologyDepartment of MedicineTaipei Veterans General HospitalTaipeiROC
| | - Sabine Ernst
- Department of CardiologyRoyal Brompton and Harefield HospitalImperial College LondonLondonUK
| | | | - Seongwook Han
- Division of CardiologyDepartment of Internal MedicineKeimyung University School of MedicineDaeguRepublic of Korea
| | - Zbigniew Kalarus
- Department of CardiologyMedical University of SilesiaKatowicePoland
| | - Carlos Labadet
- Cardiology DepartmentArrhythmias and Electrophysiology ServiceClinica y Maternidad Suizo ArgentinaBuenos AiresArgentina
| | - Yenn‐Jian Lin
- Division of CardiologyDepartment of MedicineTaipei Veterans General HospitalTaipeiROC
| | - Li‐Wei Lo
- Division of CardiologyDepartment of MedicineTaipei Veterans General HospitalTaipeiROC
| | - Akihiko Nogami
- Department of CardiologyFaculty of MedicineUniversity of TsukubaTsukubaJapan
| | - Eduardo B. Saad
- Center for Atrial FibrillationHospital Pro‐CardiacoRio de JaneiroBrazil
| | - John Sapp
- Division of CardiologyDepartment of MedicineQEII Health Sciences CentreDalhousie UniversityHalifaxNSCanada
| | | | - Roland Tilz
- Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine)University Hospital Schleswig‐Holstein (UKSH) – Campus LuebeckLuebeckGermany
| | - Roderick Tung
- Center for Arrhythmia CarePritzker School of MedicineUniversity of Chicago MedicineChicagoILUSA
| | - Yun Gi Kim
- Department of Internal MedicineArrhythmia CenterKorea University Medicine Anam HospitalSeoulRepublic of Korea
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Clinical spectrum and long-term course of sustained ventricular tachycardia in pediatric patients: 10 years of experience. Anatol J Cardiol 2020; 25:313-322. [PMID: 33960306 DOI: 10.14744/anatoljcardiol.2020.95759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE Pediatric ventricular tachycardias (VTs) have heterogeneous etiology and different clinical features. This study aimed to evaluate the clinical spectrum and long-term course of pediatric sustained VTs. METHODS Patients diagnosed as having sustained VT between 2010 and 2020 were evaluated retrospectively. RESULTS A total of 129 patients with VT were evaluated; 74 patients were male, and the median age was 12.5 years (0.25-18 years). Patients were grouped as having idiopathic VT (IVT) [n=85 (65.9%)], cardiomyopathy-associated VT (CMP-VT) [n=24 (18.6%)], catecholaminergic polymorphic VT [n=17 (13.2%)], and myocarditis-associated VT [n=3, (2.3%)]. Palpitations (n=61) and syncope (n=24) were the most common symptoms. VT originated from the right ventricle in 53.6% of the patients. Half of the patients underwent electrophysiological study, 64 patients received radiofrequency ablation therapy, and 29 patients had implantable cardiac defibrillators. During the follow-up, 70.4% of all patients had complete resolution, whereas 19 patients had a partial resolution and 23 patients (19.5%) had stable disease. Monomorphic VTs and VTs with left bundle bunch block were more thriving controlled (p=0.02 vs. p=0.04). In terms of long-term results, no statistical difference was found among the VT groups (p=0.39). Deaths were observed only in IVT (n=1) and CMP-VT (n=8) groups (p<0.001), and the overall mortality rate of pediatric sustained VT was observed at 6.9% in this study. CONCLUSION VTs, which can cause sudden cardiac arrest, are potentially life-threatening arrhythmias. Identifying the heterogeneity of this VT and its peculiar characteristics would facilitate appropriate diagnosis and therapy.
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14
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Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Della Bella P, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Saenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. Heart Rhythm 2019; 17:e2-e154. [PMID: 31085023 PMCID: PMC8453449 DOI: 10.1016/j.hrthm.2019.03.002] [Citation(s) in RCA: 199] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Indexed: 01/10/2023]
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
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Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, California
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
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15
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Chung FP, Van Ba V, Lin YJ, Chang SL, Lo LW, Hu YF, Tuan TC, Chao TF, Liao JN, Lin CY, Hsieh MH, Chen SA. The prevalence and characteristics of coexisted atrioventricular nodal reentrant tachycardia and idiopathic left fascicular ventricular tachycardia. J Cardiovasc Electrophysiol 2018; 29:1096-1103. [DOI: 10.1111/jce.13628] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 04/14/2018] [Accepted: 05/01/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Fa-Po Chung
- Heart Rhythm Center and Division of Cardiology, Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Center; National Yang-Ming University; Taipei Taiwan
| | - Vu Van Ba
- Heart Rhythm Center and Division of Cardiology, Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Center; National Yang-Ming University; Taipei Taiwan
| | - Yenn-Jiang Lin
- Heart Rhythm Center and Division of Cardiology, Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Center; National Yang-Ming University; Taipei Taiwan
| | - Shih-Lin Chang
- Heart Rhythm Center and Division of Cardiology, Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Center; National Yang-Ming University; Taipei Taiwan
| | - Li-Wei Lo
- Heart Rhythm Center and Division of Cardiology, Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Center; National Yang-Ming University; Taipei Taiwan
| | - Yu-Feng Hu
- Heart Rhythm Center and Division of Cardiology, Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Center; National Yang-Ming University; Taipei Taiwan
| | - Ta-Chuan Tuan
- Heart Rhythm Center and Division of Cardiology, Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Center; National Yang-Ming University; Taipei Taiwan
| | - Tze-Fan Chao
- Heart Rhythm Center and Division of Cardiology, Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Center; National Yang-Ming University; Taipei Taiwan
| | - Jo-Nan Liao
- Heart Rhythm Center and Division of Cardiology, Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Center; National Yang-Ming University; Taipei Taiwan
| | - Chin-Yu Lin
- Heart Rhythm Center and Division of Cardiology, Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Center; National Yang-Ming University; Taipei Taiwan
| | - Ming-Hsiung Hsieh
- Division of Cardiology, Department of Internal Medicine, Wan Fang Hospital; Taipei Medical University; Taipei Taiwan
| | - Shih-Ann Chen
- Heart Rhythm Center and Division of Cardiology, Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Center; National Yang-Ming University; Taipei Taiwan
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16
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Ma W, Lu F, Shehata M, Wang X, Zhang F, Chen B, Wu D, He L, Sun S, Cheng A, Ding J, Cong H, Xu J. Catheter Ablation of Idiopathic Left Posterior Fascicular Ventricular Tachycardia. Circ Arrhythm Electrophysiol 2017; 10:CIRCEP.117.005240. [PMID: 29138142 DOI: 10.1161/circep.117.005240] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 09/20/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Wei Ma
- From the Tianjin Medical University, China (W.M., H.C.); Heart Institute, Tianjin Chest Hospital, China (W.M., F.L., F.Z., B.C., D.W., L.H., S.S., A.C., J.D., H.C., J.X.); and Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA (M.S., X.W.)
| | - Fengmin Lu
- From the Tianjin Medical University, China (W.M., H.C.); Heart Institute, Tianjin Chest Hospital, China (W.M., F.L., F.Z., B.C., D.W., L.H., S.S., A.C., J.D., H.C., J.X.); and Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA (M.S., X.W.)
| | - Michael Shehata
- From the Tianjin Medical University, China (W.M., H.C.); Heart Institute, Tianjin Chest Hospital, China (W.M., F.L., F.Z., B.C., D.W., L.H., S.S., A.C., J.D., H.C., J.X.); and Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA (M.S., X.W.)
| | - Xunzhang Wang
- From the Tianjin Medical University, China (W.M., H.C.); Heart Institute, Tianjin Chest Hospital, China (W.M., F.L., F.Z., B.C., D.W., L.H., S.S., A.C., J.D., H.C., J.X.); and Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA (M.S., X.W.)
| | - Fan Zhang
- From the Tianjin Medical University, China (W.M., H.C.); Heart Institute, Tianjin Chest Hospital, China (W.M., F.L., F.Z., B.C., D.W., L.H., S.S., A.C., J.D., H.C., J.X.); and Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA (M.S., X.W.)
| | - Bingwei Chen
- From the Tianjin Medical University, China (W.M., H.C.); Heart Institute, Tianjin Chest Hospital, China (W.M., F.L., F.Z., B.C., D.W., L.H., S.S., A.C., J.D., H.C., J.X.); and Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA (M.S., X.W.)
| | - Dongyan Wu
- From the Tianjin Medical University, China (W.M., H.C.); Heart Institute, Tianjin Chest Hospital, China (W.M., F.L., F.Z., B.C., D.W., L.H., S.S., A.C., J.D., H.C., J.X.); and Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA (M.S., X.W.)
| | - Le He
- From the Tianjin Medical University, China (W.M., H.C.); Heart Institute, Tianjin Chest Hospital, China (W.M., F.L., F.Z., B.C., D.W., L.H., S.S., A.C., J.D., H.C., J.X.); and Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA (M.S., X.W.)
| | - Shan Sun
- From the Tianjin Medical University, China (W.M., H.C.); Heart Institute, Tianjin Chest Hospital, China (W.M., F.L., F.Z., B.C., D.W., L.H., S.S., A.C., J.D., H.C., J.X.); and Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA (M.S., X.W.)
| | - Aijuan Cheng
- From the Tianjin Medical University, China (W.M., H.C.); Heart Institute, Tianjin Chest Hospital, China (W.M., F.L., F.Z., B.C., D.W., L.H., S.S., A.C., J.D., H.C., J.X.); and Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA (M.S., X.W.)
| | - Jun Ding
- From the Tianjin Medical University, China (W.M., H.C.); Heart Institute, Tianjin Chest Hospital, China (W.M., F.L., F.Z., B.C., D.W., L.H., S.S., A.C., J.D., H.C., J.X.); and Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA (M.S., X.W.)
| | - Hongliang Cong
- From the Tianjin Medical University, China (W.M., H.C.); Heart Institute, Tianjin Chest Hospital, China (W.M., F.L., F.Z., B.C., D.W., L.H., S.S., A.C., J.D., H.C., J.X.); and Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA (M.S., X.W.)
| | - Jing Xu
- From the Tianjin Medical University, China (W.M., H.C.); Heart Institute, Tianjin Chest Hospital, China (W.M., F.L., F.Z., B.C., D.W., L.H., S.S., A.C., J.D., H.C., J.X.); and Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA (M.S., X.W.)
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17
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[Current strategies in the treatment of ventricular tachycardia by catheter ablation : A review]. Herz 2017; 43:628-632. [PMID: 28884341 DOI: 10.1007/s00059-017-4615-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 07/21/2017] [Accepted: 08/08/2017] [Indexed: 10/18/2022]
Abstract
The treatment of ventricular tachycardia has recently undergone relevant changes as certain interventional treatment options, such as radiofrequency catheter ablation, have gained in importance. Numerous current publications have demonstrated the advantages of catheter ablation compared to conventional therapy with antiarrhythmic drugs in terms of effectiveness and morbidity. Improving the ablation technique and identifying those patient collectives who are most likely to benefit from ablation are still the objectives of current research. The treatment of ventricular tachycardia in the setting of different cardiac and non-cardiac conditions can be challenging and requires understanding of the current procedures and the recommendations for catheter ablation of ventricular tachycardia. This review succinctly summarizes the current research in this evolving field of interventional cardiology.
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18
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Balla C, Ali H, Cappato R. Ventricular tachycardia as the first manifestation of disease: an element with different clinical settings. J Cardiovasc Med (Hagerstown) 2017; 18 Suppl 1:e77-e82. [PMID: 28151771 DOI: 10.2459/jcm.0000000000000452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Cristina Balla
- aArrhythmia and Electrophysiology Research Center, IRCCS Humanitas Research Hospital, Rozzano, Milan bArrhythmia and Electrophysiology Unit II, Humanitas Gavazzeni Clinics, Bergamo cDepartment of Cardiology, SS. ma Annunziata Hospital, Azienda Unità Sanitaria Locale Ferrara, Cento, Ferrara, Italy
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19
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Chen H, Zhang F, Yang B, Shehata M, Ju W, Yang G, Gu K, Li M, Cao K, Chen M, Wang X. A novel method to identify the origin of ventricular tachycardia from the left fascicular system. Heart Rhythm 2016; 13:686-94. [DOI: 10.1016/j.hrthm.2015.12.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Indexed: 10/22/2022]
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20
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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: 29] [Impact Index Per Article: 3.2] [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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21
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CHEN YIHE, LIN JIAFENG. Catheter Ablation of Idiopathic Epicardial Ventricular Arrhythmias Originating from the Vicinity of the Coronary Sinus System. J Cardiovasc Electrophysiol 2015; 26:1160-7. [PMID: 26175213 DOI: 10.1111/jce.12756] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 06/18/2015] [Accepted: 07/08/2015] [Indexed: 11/28/2022]
Affiliation(s)
- YI-HE CHEN
- Department of Cardiology; Second Affiliated Hospital of Wenzhou Medical College; Wenzhou Zhejiang China
| | - JIA-FENG LIN
- Department of Cardiology; Second Affiliated Hospital of Wenzhou Medical College; Wenzhou Zhejiang China
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22
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Igarashi M, Nogami A, Sekiguchi Y, Kuroki K, Yamasaki H, Machino T, Yui Y, Ogawa K, Talib AK, Murakoshi N, Kuga K, Aonuma K. The QRS morphology pattern in V5R is a novel and simple parameter for differentiating the origin of idiopathic outflow tract ventricular arrhythmias. Europace 2015; 17:1107-16. [PMID: 25564550 DOI: 10.1093/europace/euu337] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 10/21/2014] [Indexed: 11/13/2022] Open
Abstract
AIMS There are many reports on the ECG characteristics of idiopathic outflow tract ventricular arrhythmias (OT-VAs) to predict their origin. However, differentiating near regions using 12-lead ECGs is still complicated. The synthesized 18-lead ECG derived from the 12-lead ECG can provide virtual waveforms of the right-sided chest leads (V3R, V4R, and V5R) and back leads (V7, V8, and V9). The aim of this study was to develop a simple and useful parameter for differentiating OT-VA origins using the 18-lead ECG. METHODS AND RESULTS We studied 28 and 73 patients with idiopathic VAs in a pacemapping study and validation cohort, respectively. In the pacemapping study, several sites out of five different sites were paced in each patient: the anterior and posterior right ventricular OT (RVOT-ant and RVOT-post), right and left coronary cusps (RCC and LCC), and junction of both cusps (RLJ). The 18-lead ECGs during pacemapping among the five sites were compared for establishing a simple parameter to predict VA origins. A novel parameter using 18-lead ECGs was tested prospectively in 73 patients. In the pacemapping study, the dominant QRS morphology pattern in the synthesized V5R significantly differed among those sites (RVOT-ant:Rs, RVOT-post:rS, RCC:QS, RLJ:qR, and LCC:R). The patients in the validation cohort were divided into five groups depending on those QRS morphology patterns during VAs in the synthesized V5R. Each V5R QRS morphology pattern could predict a precise origin of the OT-VAs with an overall accuracy of 75%. CONCLUSION The QRS morphology pattern in V5R was a simple and useful parameter for differentiating detailed OT-VA origins.
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Affiliation(s)
- Miyako Igarashi
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Akihiko Nogami
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Yukio Sekiguchi
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Kenji Kuroki
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Hiro Yamasaki
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Takeshi Machino
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Yoshiaki Yui
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Kojiro Ogawa
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Ahmed Karim Talib
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Nobuyuki Murakoshi
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Keisuke Kuga
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Kazutaka Aonuma
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
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23
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Kumagai K. Idiopathic ventricular arrhythmias arising from the left ventricular outflow tract: Tips and tricks. J Arrhythm 2014. [DOI: 10.1016/j.joa.2014.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Abstract
This report describes a patient presenting with a narrow complex tachycardia in the context of prior myocardial infarction and impaired ventricular function. Electrophysiological studies confirmed ventricular tachycardia and activation and entrainment mapping demonstrated a critical isthmus within an area of scar involving the His-Purkinje system accounting for the narrow QRS morphology. This very rare case shares some similarities with upper septal ventricular tachycardia seen in patients with structurally normal hearts, but to our knowledge has not been seen previously in patients with ischemic heart disease.
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Adjei FD, Gajendragadkar PR. A narrow complex tachycardia for the broad minded. QJM 2014; 107:401-2. [PMID: 24049055 DOI: 10.1093/qjmed/hct185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ying Z, Lv X, Ma J, Wang J, Bian C. Ablation of premature ventricular contractions originating from the left ventricular septum. Int J Cardiol 2014; 172:e84-6. [PMID: 24405837 DOI: 10.1016/j.ijcard.2013.12.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Accepted: 12/21/2013] [Indexed: 10/25/2022]
Affiliation(s)
- Zhiqiang Ying
- Department of Cardiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou 310009, China
| | - Xingguang Lv
- Department of Cardiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou 310009, China
| | - Ji Ma
- Department of Cardiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou 310009, China
| | - Jie Wang
- Department of Cardiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou 310009, China
| | - Chan Bian
- Department of Cardiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou 310009, China.
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Ghanbari H, Schmidt M, Machado C, Daccarett M. Catheter ablation of ventricular tachycardia in structurally normal hearts. Expert Rev Cardiovasc Ther 2014; 8:651-61. [DOI: 10.1586/erc.10.25] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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28
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Technical note: Electrocardiogram electrode repositioning for 320-row coronary CT angiography in patients with regular and recurrent premature ventricular contractions. J Cardiovasc Comput Tomogr 2014; 8:13-8. [DOI: 10.1016/j.jcct.2013.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 10/15/2013] [Accepted: 12/16/2013] [Indexed: 11/23/2022]
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29
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Ventricular arrhythmias from the mitral annulus: Patient characteristics, electrophysiological findings, ablation, and prognosis. Heart Rhythm 2013; 10:783-8. [DOI: 10.1016/j.hrthm.2013.02.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Indexed: 11/21/2022]
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30
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Hoffmayer KS, Gerstenfeld EP. Diagnosis and Management of Idiopathic Ventricular Tachycardia. Curr Probl Cardiol 2013; 38:131-58. [DOI: 10.1016/j.cpcardiol.2013.02.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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31
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Nishiuchi S, Nogami A, Naito S. A case with occurrence of antidromic tachycardia after ablation of idiopathic left fascicular tachycardia: mechanism of left upper septal ventricular tachycardia. J Cardiovasc Electrophysiol 2013; 24:825-7. [PMID: 23350939 DOI: 10.1111/jce.12072] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 11/27/2012] [Accepted: 12/06/2012] [Indexed: 11/28/2022]
Abstract
A 36-year-old male presented with verapamil-sensitive narrow QRS tachycardia. The patient underwent the catheter ablation of common idiopathic left fascicular ventricular tachycardia (ILVT) 2 years ago. During narrow QRS tachycardia, the diastolic and presystolic potentials (P1 and P2) were recorded at the left septum. Activation sequences of P1 and P2 were opposite from those in common ILVT. Entrainment of P1 at the upper septum exhibited concealed fusion and S-QRS equal to P1-QRS. Radiofrequency current to P1 suppressed VT. Idiopathic left upper septal VT might be the antidromic macroreentry of the common form of ILVT.
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Affiliation(s)
- Suguru Nishiuchi
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Gunma, Japan.
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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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33
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Cecchi E, Fatucchi S, Crudeli E, Giglioli C. Role of electrophysiological study and catheter ablation for recurrent ventricular tachycardia complicating myocarditis. ACTA MEDICA (HRADEC KRÁLOVÉ) 2012; 55:96-9. [PMID: 23101274 DOI: 10.14712/18059694.2015.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Here we report the case of a 31-year-old man admitted to our hospital with echocardiografic and Cardiac Magnetic Resonance signs of myocarditis complicated by ventricular tachycardia, initially resolved with direct current shock. After the recurrence of ventricular tachycardia the patient was submitted to electrophysiological study revealing a re-entrant circuit at the level of the medium segment of interventricular septum, successfully treated with transcatheter ablation. This case highlights how the presence of recurrent ventricular arrhythmias at the onset of acute myocarditis, suspected or proven, could be associated with a pre-existing arrhythmogenic substrate, therefore these patients should be submitted to electrophysiological study in order to rule out the presence of arrhythmogenic focuses that can be treated with transcatheter ablation.
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Affiliation(s)
- Emanuele Cecchi
- Department of Heart and Vessels, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
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34
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Yamada T. Electrocardiographic algorithms to localize the origins of idiopathic ventricular arrhythmias. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2012; 35:1514-5. [PMID: 23035983 DOI: 10.1111/pace.12002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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35
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Tang WH, Lee KT, Tsai WC, Lai WT. Wide QRS tachycardia with two P wave morphologies: What is the mechanism? Kaohsiung J Med Sci 2012; 28:404-5. [DOI: 10.1016/j.kjms.2012.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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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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38
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Metzner A, Ouyang F, Wissner E, Kuck KH. Monomorphic and polymorphic ventricular tachycardias arising from the His–Purkinje system: what do we know? Future Cardiol 2011; 7:835-46. [DOI: 10.2217/fca.11.60] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Monomorphic and polymorphic Purkinje-related ventricular tachycardias (VTs) may occur in patients with and without underlying structural heart disease. Monomorphic Purkinje-related VTs can be divided into different entities: verapamil-sensitive left fascicular VTs; bundle branch reentry tachycardias (BBRT); interfascicular VTs and focal Purkinje VTs. The most frequent fascicular VT is left posterior fascicular VT, characterized by macro-reentry within the posterior Purkinje network. However, the reentry may also be located in the anterior Purkinje network (left anterior fascicular VT). BBRT is also a macro-reentry-tachycardia, utilizing both the right and the left bundle branch as the antegrade and the retrograde limb and is often associated with pre-existing conduction disturbances in the specific conduction system. Interfascicular VT is rare and characterized by a macro-reentry within the left fascicles. BBRT and interfascicular VT may also occur in the same patient. In contrast to the mentioned macro-reentry mechanisms there are focal Purkinje-related VTs arising from the anterior or posterior Purkinje system. Focal Purkinje triggered premature ventricular contractions originating from the distal Purkinje arborization in patients without a structural heart disease, as well as in patients with known ischemic heart disease or an underlying channelopathy such as Brugada syndrome may induce polymorphic VTs. Catheter ablation is an effective treatment option for both monomorphic as well as polymorphic Purkinje-related VTs, often resulting in noninducibility and freedom from VT recurrence. A systematic analysis of the surface ECG and the intracardiac electrograms is essential for successful ablation of these heterogeneous and potentially curable VTs.
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Affiliation(s)
| | - Feifan Ouyang
- Asklepios-Klinik St. Georg, Department of Cardiology, Lohmühlenstr. 5, 20099 Hamburg, Germany
| | - Erik Wissner
- Asklepios-Klinik St. Georg, Department of Cardiology, Lohmühlenstr. 5, 20099 Hamburg, Germany
| | - Karl-Heinz Kuck
- Asklepios-Klinik St. Georg, Department of Cardiology, Lohmühlenstr. 5, 20099 Hamburg, Germany
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Lee HW, Kim JB, Joung B, Lee MH, Kim SS. Successful catheter ablation of focal automatic left ventricular tachycardia presented with tachycardia-mediated cardiomyopathy. Yonsei Med J 2011; 52:1022-4. [PMID: 22028169 PMCID: PMC3220244 DOI: 10.3349/ymj.2011.52.6.1022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Non-reentrant focal tachycardias occur spontaneously, facilitated by catecholamine infusion, but they cannot be initiated or terminated with programmed stimulation. These tachycardias exhibit early activation before the QRS, however, do not typically show the mid-diastolic potential that is crucial for reentrant tachycardia maintenance. Electrophysiological studies are useful for distinguishing focal from macro-reentrant ventricular tachycardia. We report herein a case of patient without a history of structural heart disease who presented with a focal Purkinje ventricular tachycardia and heart failure. The focal Purkinje ventricular tachycardia was eliminated by radiofrequency catheter ablation. All of the patient's symptoms were improved after ablation.
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Affiliation(s)
- Hee-Woo Lee
- Cardiology Division, Department of Internal Medicine, Kwandong University College of Medicine, Goyang, Korea
| | - Jin-Bae Kim
- Cardiology Division, Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Korea
| | - Boyoung Joung
- Cardiology Division, Yonsei Cardiovascular Center and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Moon-Hyoung Lee
- Cardiology Division, Yonsei Cardiovascular Center and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sung-Soon Kim
- Cardiology Division, Yonsei Cardiovascular Center and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Jia L, Yue-Chun L, Kang-Ting J, Na-Dan Z, Jia-Xuan L, Wen-Wu Z, Peng-Lin Y, Ji-Fei T, Jia-Feng L. Premature ventricular contractions originating from the left ventricular septum: results of radiofrequency catheter ablation in twenty patients. BMC Cardiovasc Disord 2011; 11:27. [PMID: 21635765 PMCID: PMC3123650 DOI: 10.1186/1471-2261-11-27] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Accepted: 06/02/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND RFCA has been established as an effective and curative therapy for severely symptomatic PVC from the outflow tract in structurally normal hearts. However, it is unknown whether PVCs originating from the left ventricular septum, are effectively eliminated by RFCA. This study aimed to investigate electrophysiologic characteristics and effects of radiofrequency catheter ablation (RFCA) for patients with symptomatic premature ventricular contraction (PVC) originating from the left ventricular septum without including fascicular PVCs. METHODS Characteristics of body surface electrocardiogram (ECG) and electrophysiologic recordings endocardiogram in a successful RFCA target were analyzed in 20 patients with symptomatic PVCs originating from the left ventricular septum. RFCA was performed using pace mapping and activation mapping. RESULTS The QRS morphology of PVCs originating from the left ventricular septum is similar to that seen in fascicular tachycardia. Most of the PVCs originated from the left septum appears in the form of ventricular parasystole. The incidence of ventricular parasystole was 70%. Sustained ventricular tachycardia was not inducible by electrical stimulation and isoproterenol infusion in all 20 patients, ablation at the site recording the earliest Purkinje potential was not effective in all 20 patients, and Purkinje potentials were not identified at successful sites during point mapping. Sixteen patients were successful with RFCA using pace mapping and activation mapping, 3 failed, and 1 recurrent. CONCLUSION Although the ECG characteristics of the PVCs arising from the left ventricular septum are similar to that seen in fascicular tachycardia, the electrophysiologic characteristics are different between the two types of PVCs. The distinguishing characteristic of the PVCs is that Purkinje potentials were not present at the site of successful ablation, suggesting a myocardial as opposed to fascicular substrate. RFCA is an effective curative therapy for symptomatic PVCs originating from the left ventricular septum (not from the left anterior and posterior fascicle).
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Affiliation(s)
- Li Jia
- Department of Cardiology, Second Affiliated Hospital of Wenzhou Medical College, Wenzhou 325000, China
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41
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Answer to the rhythm puzzle. Neth Heart J 2011; 19:311-3. [DOI: 10.1007/s12471-011-0142-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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42
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Pellegrini CN, Scheinman MM, Badhwar N. Idiopathic epicardial ventricular tachycardia with origin remote from vascular structures. J Electrocardiol 2011; 44:792-5. [PMID: 21419422 DOI: 10.1016/j.jelectrocard.2011.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Indexed: 11/28/2022]
Abstract
We report a case of a patient with idiopathic left ventricular tachycardia (VT) successfully ablated from the epicardial aspect of the left ventricle, after a previous failed endocardial ablation. The VT appeared to be catecholamine sensitive. An excellent epicardial pacemap was found in the midlateral region of the left ventricle, remote from vascular structures. Following ablation, the patient discontinued antiarrhythmic drug use and has not experienced any recurrence of VT for more than 2 1/2 years.
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Affiliation(s)
- Cara N Pellegrini
- Department of Medicine, Cardiac Electrophysiology, San Francisco VAMC, San Francisco, CA 94121, USA.
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43
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NOGAMI AKIHIKO. Purkinje-Related Arrhythmias Part I: Monomorphic Ventricular Tachycardias. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2011; 34:624-50. [DOI: 10.1111/j.1540-8159.2011.03044.x] [Citation(s) in RCA: 136] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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44
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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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46
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Viswanathan MN, Page RL. Acute Antiarrhythmic Therapy of Ventricular Tachycardia and Ventricular Fibrillation. Card Electrophysiol Clin 2010; 2:429-441. [PMID: 28770801 DOI: 10.1016/j.ccep.2010.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Ventricular arrhythmias (ventricular tachycardia and ventricular fibrillation) are often associated with underlying structural heart disease and require prompt assessment and treatment. Acute treatment involves initial hemodynamic stabilization of the patient followed by suppressive treatment with pharmacologic and nonpharmacologic approaches for reducing the risk of recurrence of ventricular arrhythmias and potential development of sudden cardiac death. This article reviews acute antiarrhythmic drug therapy for ventricular arrhythmias based on the clinical presentation.
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Affiliation(s)
- Mohan N Viswanathan
- Division of Cardiology/Cardiac Electrophysiology, University of Washington, Box 356422, 1959 NE Pacific Street, A-506B, Seattle, WA 98195-6422, USA
| | - Richard L Page
- Department of Medicine, University of Wisconsin, School of Medicine & Public Health, J5/219 Clinical Science Center MC2454, 600 Highland Avenue, Madison, WI 53792, USA
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YOKOSHIKI HISASHI, MITSUYAMA HIROFUMI, UENO MICHIHIKO, TSUTSUI HIROYUKI. Idiopathic Reentrant Right Ventricular Outflow Tract Tachycardia With Presystolic Potential of Central Pathway. J Cardiovasc Electrophysiol 2010; 21:1174-7. [DOI: 10.1111/j.1540-8167.2010.01751.x] [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] [Indexed: 11/27/2022]
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48
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Song MK, Baek JS, Kwon BS, Kim GB, Bae EJ, Noh CI, Choi JY. Clinical Spectrum and Prognostic Factors of Pediatric Ventricular Tachycardia. Circ J 2010; 74:1951-8. [DOI: 10.1253/circj.cj-10-0264] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Mi-Kyoung Song
- Department of Pediatrics, Seoul National University Children's Hospital
| | - Jae-Suk Baek
- Department of Pediatrics, Seoul National University Children's Hospital
| | - Bo-Sang Kwon
- Department of Pediatrics, Seoul National University Children's Hospital
| | - Gi-Beom Kim
- Department of Pediatrics, Seoul National University Children's Hospital
| | - Eun-Jung Bae
- Department of Pediatrics, Seoul National University Children's Hospital
| | - Chung-Il Noh
- Department of Pediatrics, Seoul National University Children's Hospital
| | - Jung-Yun Choi
- Department of Pediatrics, Seoul National University Children's Hospital
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49
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Chou CJ, Lee CS, Lai WT. Ventricular Tachycardia With Hemodynamic Instability Refractory to Cardioversion: A Case Report. Kaohsiung J Med Sci 2009; 25:675-9. [DOI: 10.1016/s1607-551x(09)70574-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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50
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Yamada T, McElderry HT, Okada T, Murakami Y, Doppalapudi H, Yoshida N, Allred JD, Murohara T, Kay GN. Idiopathic Focal Ventricular Arrhythmias Originating from the Anterior Papillary Muscle in the Left Ventricle. J Cardiovasc Electrophysiol 2009; 20:866-72. [PMID: 19298560 DOI: 10.1111/j.1540-8167.2009.01448.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Takumi Yamada
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama 35294-0019, USA.
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