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Nogami A, Komatsu Y, Talib AK, Phanthawimol W, Naeemah QJ, Haruna T, Morishima I. Purkinje-Related Ventricular Tachycardia and Ventricular Fibrillation: Solved and Unsolved Questions. JACC Clin Electrophysiol 2023; 9:2172-2196. [PMID: 37498247 DOI: 10.1016/j.jacep.2023.05.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/05/2023] [Accepted: 05/24/2023] [Indexed: 07/28/2023]
Abstract
Of the monomorphic ventricular tachycardias, there are 4 specific tachycardias related to the Purkinje system: 1) idiopathic verapamil-sensitive fascicular ventricular tachycardia (FVT); 2) non-re-entrant FVT; 3) bundle branch re-entry and interfascicular re-entry; and 4) Purkinje-mediated VT in structural heart disease. Verapamil-sensitive FVT is classified into 4 types according to the location of the circuit: 1) left posterior type; 2) left anterior type; 3) left upper septal type;and 4) reverse type. And, in the left anterior and posterior types, there are septal and papillary muscle subtypes. Although macro-re-entry has been reported to be the mechanism underlying verapamil-sensitive FVT, recording the entire circuit is challenging. One possible reason is that the Purkinje-muscle junction may penetrate the myocardial layer as a part of the circuit. The Purkinje network may thus play an important role in the initiation and maintenance of ventricular fibrillation. Further, it has been reported that the development and the abnormalities of the Purkinje system are associated with the arrhythmogenesis of ventricular fibrillation. Furthermore, it has been reported that catheter ablation of trigger ventricular premature complexes, and/or "de-networking" of the Purkinje system, can be used as electrical bailout therapy. There is a hypothesis that the intramural Purkinje system is involved in the generation of J waves. Nevertheless, as there are still unresolved issues that must be debated and accurately analyzed, this review aims to discuss the solved and unsolved questions related to Purkinje-related arrhythmias.
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Affiliation(s)
- Akihiko Nogami
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan; Institute of Arrhythmia, Tokyo Heart Rhythm Hospital, Tokyo, Japan.
| | - Yuki Komatsu
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Ahmed Karim Talib
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan; Faculty of Medicine, University of Kufa, Najaf, Iraq
| | - Wipat Phanthawimol
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan; Cardiac Electrophysiology Unit, Division of Cardiology, Central Chest Institute of Thailand, Nonthaburi, Thailand
| | - Qasim J Naeemah
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan; Faculty of Medicine, University of Kufa, Najaf, Iraq
| | - Tetsuya Haruna
- Cardiovascular Center, Medical Research Institute Kitano Hospital, Osaka, Japan
| | - Itsuro Morishima
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
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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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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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Phanthawimol W, Nogami A, Haruna T, Morishima I, Hasebe H, Mizutani Y, Naeemah QJ, Shimoo S, Hattori M, Ichihara N, Komatsu Y, Kuroki K, Yamasaki H, Igarashi M, Aonuma K, Ieda M. Reverse-Type Left Posterior Fascicular Ventricular Tachycardia: A New Electrocardiographic Entity. JACC Clin Electrophysiol 2021; 7:843-854. [PMID: 33640356 DOI: 10.1016/j.jacep.2020.11.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/18/2020] [Accepted: 11/18/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVES This study sought to demonstrate a new type of verapamil-sensitive fascicular ventricular tachycardia (VT) with a reverse circuit. BACKGROUND Left posterior fascicular ventricular tachycardia (LPFVT) is the most common form of verapamil-sensitive fascicular VT. Reverse-type LPFVT has not been reported. METHODS We searched for a reverse-type LPFVT among 242 patients with verapamil-sensitive VT from February 2006 to September 2019. RESULTS Three patients had a reverse-type LPFVT (cycle lengths: 340, 360, and 340 ms). QRS configuration during VT was narrow (140, 150, and 140 ms) and exhibited rSr' morphology in V1 with an early precordial transition and inferior axis. Two of 3 patients had common-type LPFVT. During reverse-type LPFVT, the earliest ventricular activation was the left superior middle septum. Fragmented Purkinje potentials (P1) buried within the local ventricular electrogram were recorded with an activation sequence from the apex to the base and were linked to the subsequent left ventricular septal activation. After radiofrequency catheter ablation at P1 during LPFVT, the reverse-type LPFVT also became noninducible. In 1 patient with only the reverse-type LPFVT, radiofrequency catheter ablation at the earliest LV activation site suppressed VT. These findings suggest that this new type of verapamil-sensitive fascicular VT shares a re-entrant circuit with a reverse direction of common LPFVT with an intramural exit site at the superior middle septum. CONCLUSIONS Reverse-type LPFVT can occur. If common LPFVT exists, diastolic P1 during LPFVT can be a common target of ablation. If only reverse-LPFVT is inducible, the earliest ventricular activation site can be a target.
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Affiliation(s)
- Wipat Phanthawimol
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Akihiko Nogami
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
| | | | - Itsuro Morishima
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Hideyuki Hasebe
- Division of Arrhythmology, Shizuoka Saiseikai General Hospital, Shizuoka, Japan
| | - Yoshiaki Mizutani
- Department of Cardiology, Yokkaichi Municipal Hospital, Yokkaichi, Japan
| | - Qasim J Naeemah
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Satoshi Shimoo
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masayuki Hattori
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Noboru Ichihara
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yuki Komatsu
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kenji Kuroki
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiro Yamasaki
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Miyako Igarashi
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kazutaka Aonuma
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masaki Ieda
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Kim M, Kwon CH, Lee JH, Hwang KW, Choi HO, Kim YG, Lee KN, Ahn J, Park HS, Nam GB. Right bundle branch block-type wide QRS complex tachycardia with a reversed R/S complex in lead V 6: Development and validation of electrocardiographic differentiation criteria. Heart Rhythm 2020; 18:181-188. [PMID: 32927100 DOI: 10.1016/j.hrthm.2020.08.023] [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] [Received: 05/11/2020] [Revised: 08/13/2020] [Accepted: 08/30/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Differentiation of supraventricular tachycardia (SVT) with a right bundle branch block (RBBB) pattern from ventricular tachycardia (VT) is difficult, particularly when the R/S ratio in lead V6 is below 1.0. OBJECTIVE We sought to investigate the electrocardiographic criteria for distinguishing between these arrhythmias. METHODS We investigated electrocardiographic parameters from 111 consecutive patients who had RBBB pattern wide QRS complex tachycardia with a reversed R/S ratio in lead V6 (72 VTs, 39 SVTs). Diagnostic criteria from the previous algorithms were compared with our new criterion, the RS/QRS ratio, which was defined as the ratio of the interval from the onset of the QRS complex to the nadir of the S wave, divided by the QRS width in lead V6. The RS/QRS ratio was further tested in a prospective population (31 fascicular VTs, 29 SVTs). RESULTS The diagnostic accuracy of previous criteria (Brugada algorithm, Vereckei algorithm, and R-wave peak time criterion) was only modest. However, the RS/QRS ratio in lead V6 was significantly lower in SVT than in VT (0.36 ± 0.04 vs 0.50 ± 0.08; P < .001). A cutoff value of the RS/QRS ratio >0.41 differentiated VT from SVT with a high diagnostic accuracy (sensitivity 97.2%; specificity 89.7%). When tested in a prospective population with fascicular VT, the diagnostic accuracy of the criteria was maintained (sensitivity 90.3%; specificity 86.2%). CONCLUSION The RS/QRS ratio >0.41 in lead V6 is a simple and reliable index for distinguishing VT from SVT in RBBB pattern wide QRS complex tachycardia with a reversed R/S complex in lead V6. This criterion was particularly useful for the differential diagnosis of fascicular VT from RBBB pattern SVT.
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Affiliation(s)
- Minsu Kim
- Division of Cardiology, School of Medicine, Chungnam National University, Chungnam National University Hospital, Daejeon, Korea
| | - Chang Hee Kwon
- Division of Cardiology, Konkuk University Medical Center, Seoul, Korea
| | - Ji Hyun Lee
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ki Won Hwang
- Divison of Cardiology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hyung Oh Choi
- Division of Cardiology, Soonchunhyang University Hospital, Bucheon, Korea
| | - Yong-Giun Kim
- Division of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Kwang-No Lee
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
| | - Jinhee Ahn
- Division of Cardiology, Pusan National University Hospital, Busan, Korea
| | - Hyoung-Seob Park
- Cardiovascular Center, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Gi-Byoung Nam
- Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
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Durrani SA, Sung R, Scheinman M. Bidirectional Ventricular Tachycardia Due to a Mixture of Focal Fascicular Firing and Reentry. Card Electrophysiol Clin 2016; 8:753-764. [PMID: 27837895 DOI: 10.1016/j.ccep.2016.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Bidirectional ventricular tachycardia (BDVT) is a well-known phenomenon since it was first described in 1922. Various mechanisms have been proposed for BDVT, including digitalis toxicity, hypokalemia, Anderson-Tawil syndrome, acute myocarditis, and catecholaminergic polymorphic ventricular tachycardia. It is characterized by rapid, wide complex electrocardiogram pattern with alternating QRS morphology and axis. The alternation of the QRS is usually right bundle branch block with 180° swings in the frontal plane axis or, less commonly, alternation of right bundle branch and left bundle branch forms. Most of the proposed mechanisms involve triggered activity or enhanced automaticity. We describe a unique BDVT, with characteristics of both re-entry and triggered activity, which terminated with a focal Rf lesion.
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Affiliation(s)
- Sarfraz A Durrani
- MedStar Heart and Vascular Institute, #501 Hamaker court, Fairfax, VA 22031, USA.
| | - Raphael Sung
- Peninsula Primary Care, Cardiology, 30 Garden Court, Suite B, Monterey, CA 93940, USA
| | - Melvin Scheinman
- University of California San Francisco Medical Center, 500 Parnassus Avenue, MUE 436, San Francisco, CA 94143-1354, USA
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Liu Y, Fang Z, Yang B, Kojodjojo P, Chen H, Ju W, Cao K, Chen M, Zhang F. Catheter Ablation of Fascicular Ventricular Tachycardia: Long-Term Clinical Outcomes and Mechanisms of Recurrence. Circ Arrhythm Electrophysiol 2015; 8:1443-51. [PMID: 26386017 PMCID: PMC4676513 DOI: 10.1161/circep.115.003080] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 09/03/2015] [Indexed: 11/23/2022]
Abstract
Supplemental Digital Content is available in the text. Fascicular ventricular tachycardia (FVT) is a common form of sustained idiopathic left ventricular tachycardia with an Asian preponderance. This study aimed to prospectively investigate long-term clinical outcomes of patients undergoing ablation of FVT and identify predictors of arrhythmia recurrence.
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Affiliation(s)
- Yaowu Liu
- From the Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China (Y.L., Z.F., B.Y., H.C., W.J., K.C., M.C., F.Z.); and Heart Center, National University Hospital, Singapore, Singapore (P.K.)
| | - Zhen Fang
- From the Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China (Y.L., Z.F., B.Y., H.C., W.J., K.C., M.C., F.Z.); and Heart Center, National University Hospital, Singapore, Singapore (P.K.)
| | - Bing Yang
- From the Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China (Y.L., Z.F., B.Y., H.C., W.J., K.C., M.C., F.Z.); and Heart Center, National University Hospital, Singapore, Singapore (P.K.)
| | - Pipin Kojodjojo
- From the Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China (Y.L., Z.F., B.Y., H.C., W.J., K.C., M.C., F.Z.); and Heart Center, National University Hospital, Singapore, Singapore (P.K.)
| | - Hongwu Chen
- From the Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China (Y.L., Z.F., B.Y., H.C., W.J., K.C., M.C., F.Z.); and Heart Center, National University Hospital, Singapore, Singapore (P.K.)
| | - Weizhu Ju
- From the Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China (Y.L., Z.F., B.Y., H.C., W.J., K.C., M.C., F.Z.); and Heart Center, National University Hospital, Singapore, Singapore (P.K.)
| | - Kejiang Cao
- From the Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China (Y.L., Z.F., B.Y., H.C., W.J., K.C., M.C., F.Z.); and Heart Center, National University Hospital, Singapore, Singapore (P.K.)
| | - Minglong Chen
- From the Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China (Y.L., Z.F., B.Y., H.C., W.J., K.C., M.C., F.Z.); and Heart Center, National University Hospital, Singapore, Singapore (P.K.)
| | - Fengxiang Zhang
- From the Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China (Y.L., Z.F., B.Y., H.C., W.J., K.C., M.C., F.Z.); and Heart Center, National University Hospital, Singapore, Singapore (P.K.).
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Puie P, Cismaru G, Muresan L, Rosu R, Puiu M, Andronache M, Gusetu G, Matuz R, Mircea PA, Pop D, Zdrenghea D. Insights into the mechanism of idiopathic left ventricular tachycardia: a case report and literature review. Eur J Med Res 2015; 20:77. [PMID: 26381389 PMCID: PMC4573491 DOI: 10.1186/s40001-015-0156-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Accepted: 07/24/2015] [Indexed: 11/10/2022] Open
Abstract
Left ventricular posterior fascicular tachycardia (LVPFT) is an idiopathic form of VT characterized by right bundle branch block morphology and left axis deviation. The mechanism of LPFVT is thought to be localized reentry close to the posterior fascicle. We present the case of a 24-year-old medical student who was admitted to the emergency department complaining of palpitations. The ECG showed an aspect suggestive of LVPFT. Vagal maneuvers, adenosine and i.v. Metoprolol were ineffective in terminating the arrhythmia. Conversion to sinus rhythm was obtained 10 h later, with i.v Amiodarone. The ECG in sinus rhythm showed left posterior fascicular block. Because antiarrhythmic drugs were not desired by the patient, VT ablation was proposed. The electrophysiological study identified the mechanism of arrhythmia to be reentry using the slowly conducting verapamil-sensitive fibers as the antegrade limb and the posterior fascicle as the retrograde limb. Radiofrequency applications near the posterior fascicle, in the lower half of the interventricular septum, at the junction of the two proximal thirds with the distal third interrupted the tachycardia and made it non-inducible at programmed stimulation. The case is unusual as the patient had a left posterior fascicular block during sinus rhythm before ablation. This demonstrates that the reentry circuit of VT does not need antegrade conduction through the posterior fascicle for perpetuation.
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Affiliation(s)
- Paul Puie
- Department of Cardiology, Rehabilitation Hospital, "Iuliu Hatieganu" University of Medicine and Pharmacy, 46-50 Viilor Street, 400347, Cluj-Napoca, Romania.
| | - Gabriel Cismaru
- Department of Cardiology, Rehabilitation Hospital, "Iuliu Hatieganu" University of Medicine and Pharmacy, 46-50 Viilor Street, 400347, Cluj-Napoca, Romania.
| | - Lucian Muresan
- Department of Cardiology, Rehabilitation Hospital, "Iuliu Hatieganu" University of Medicine and Pharmacy, 46-50 Viilor Street, 400347, Cluj-Napoca, Romania.
| | - Radu Rosu
- Department of Cardiology, Rehabilitation Hospital, "Iuliu Hatieganu" University of Medicine and Pharmacy, 46-50 Viilor Street, 400347, Cluj-Napoca, Romania.
| | - Mihai Puiu
- Department of Cardiology, Rehabilitation Hospital, "Iuliu Hatieganu" University of Medicine and Pharmacy, 46-50 Viilor Street, 400347, Cluj-Napoca, Romania.
| | - Marius Andronache
- Department of Electrophysiology, Institut Lorrain du Coeur et des Vaisseaux «Louis Mathieu», CHU de Nancy, Cluj-Napoca, France.
| | - Gabriel Gusetu
- Department of Cardiology, Rehabilitation Hospital, "Iuliu Hatieganu" University of Medicine and Pharmacy, 46-50 Viilor Street, 400347, Cluj-Napoca, Romania.
| | - Roxana Matuz
- Department of Cardiology, Rehabilitation Hospital, "Iuliu Hatieganu" University of Medicine and Pharmacy, 46-50 Viilor Street, 400347, Cluj-Napoca, Romania.
| | - Petru-Adrian Mircea
- Department of Internal Medicine, Medical Clinic No 1, "Iuliu Hatieganu", University of Medicine and Pharmacy, Cluj-Napoca, Romania.
| | - Dana Pop
- Department of Cardiology, Rehabilitation Hospital, "Iuliu Hatieganu" University of Medicine and Pharmacy, 46-50 Viilor Street, 400347, Cluj-Napoca, Romania.
| | - Dumitru Zdrenghea
- Department of Cardiology, Rehabilitation Hospital, "Iuliu Hatieganu" University of Medicine and Pharmacy, 46-50 Viilor Street, 400347, Cluj-Napoca, Romania.
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MORISHIMA ITSURO, NOGAMI AKIHIKO, TSUBOI HIDEYUKI, SONE TAKAHITO. Negative Participation of the Left Posterior Fascicle in the Reentry Circuit of Verapamil-Sensitive Idiopathic Left Ventricular Tachycardia. J Cardiovasc Electrophysiol 2012; 23:556-9. [DOI: 10.1111/j.1540-8167.2011.02251.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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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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Gellér L, Szilágyi S, Solymossy K, Srej M, Zima E, Tahin T, Merkely B. [Ablation of idiopathic fascicular ventricular tachycardia]. Orv Hetil 2009; 150:1463-9. [PMID: 19617183 DOI: 10.1556/oh.2009.28642] [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]
Abstract
Idiopathic fascicular ventricular tachycardia is an important and not very rare cardiac arrhythmia with specific electrocardiographic features and therapeutic options. Ventricular tachycardia is characterized by relatively narrow QRS complex and right bundle branch block pattern. The QRS axis depends on which fascicle is involved in the re-entry. Left axis deviation is noted with left posterior fascicular tachycardia and right axis deviation with left anterior fascicular tachycardia. A left septal fascicular tachycardia with normal QRS axis is also possible. Idiopathic fascicular tachycardia is usually seen in individuals without structural heart disease. Response to verapamil is an important feature of fascicular tachycardia. In some cases intravenous adenosine may also terminate the arrhythmia. During electrophysiology study, presystolic or diastolic potentials precede the QRS, presumed to originate from the Purkinje fibers. The potentials can be recorded during sinus rhythm and ventricular tachycardia in many patients with fascicular tachycardia. This potential (so-called Purkinje potential) has been used as a guide to catheter ablation. Correct diagnosis of fascicular tachycardia is very important because catheter ablation is very effective in the treatment of this type of ventricular tachycardia. In this review, we describe three patients with idiopathic ventricular tachycardia and their successful catheter ablation, and summarize the actual knowledge of the diagnosis and management of this special ventricular tachycardia.
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Affiliation(s)
- László Gellér
- Semmelweis Egyetem, Altalános Orvostudományi Kar, Kardiológiai Központ, Budapest.
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