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Warren P, Knilans TK, Baskar S. Using a multielectrode catheter to facilitate mapping and ablation of idiopathic fascicular ventricular tachycardia. HeartRhythm Case Rep 2023; 9:939-942. [PMID: 38204823 PMCID: PMC10774575 DOI: 10.1016/j.hrcr.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Affiliation(s)
- Paul Warren
- The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Timothy K. Knilans
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Shankar Baskar
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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2
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Sun M, Wang J, Wang Z, Liang M, Yang G, Jin Z, Liang Y, Han Y. The change of cardiac axis deviation in catheter ablation of verapamil-sensitive idiopathic left ventricular tachycardia. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:685-692. [PMID: 33559892 DOI: 10.1111/pace.14192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/07/2021] [Accepted: 02/07/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The underlying mechanism of verapamil-sensitive idiopathic left ventricular tachycardia (ILVT) has been postulated to be reentrant activation in the Purkinje fiber network of the left posterior fascicle or the left anterior fascicle (LAF). However, changing of cardiac axis deviation in sinus rhythm (SR) or during ILVT after radiofrequency catheter ablation (RFCA) has been rarely analyzed. METHODS Of the 232 patients with sustained ILVT induced and surface electrocardiogram (ECG) in SR recorded before and after RFCA, the changes of ECG morphology in SR and during ILVT were analyzed. RESULTS The surface ECG in SR changed in 114 (49.1%) patients after RFCA. ILVT could still be induced in 27 (23.7%) patients. In comparison with the original ILVT, three forms of ECG morphology were observed. In eight patients, the ILVT morphology was unchanged. In the 13 patients with ILVT axis deviation conversion after ablation, the successful target was more proximal. In the six patients with ILVT morphology change but without axis deviation conversion after ablation, the successful ablation site was more distal. Among 15 patients with recurrent ILVT during follow-up, seven patients had previous axis deviation changes in SR after RFCA, the changes maintained in four patients and recovered in three patients. CONCLUSIONS The morphology changes on surface ECG in SR after RFCA would not be a necessary prerequisite or a good endpoint for ILVT ablation. To analyze ILVT morphology changes after ablation would help to further clarify an appropriate approach for catheter ablation of ILVT.
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Affiliation(s)
- Mingyu Sun
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Jian Wang
- Department of Cardiology, Zibo Central Hospital, Zibo, China
| | - Zulu Wang
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Ming Liang
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Guitang Yang
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Zhiqing Jin
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Yanchun Liang
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Yaling Han
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
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3
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Creta A, Chow AW, Sporton S, Finlay M, Papageorgiou N, Honarbakhsh S, Dhillon G, Graham A, Patel KH, Dhinoja M, Earley MJ, Hunter RJ, Lowe M, Rowland E, Segal OR, Calabrese V, Ricciardi D, Lambiase PD, Schilling RJ, Providência R. Catheter ablation for fascicular ventricular tachycardia: A systematic review. Int J Cardiol 2019; 276:136-148. [DOI: 10.1016/j.ijcard.2018.10.080] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 10/03/2018] [Accepted: 10/24/2018] [Indexed: 11/24/2022]
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4
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Michowitz Y, Belhassen B. New Insights on Verapamil-Sensitive Idiopathic Left Fascicular Tachycardia. J Electrocardiol 2018; 51:874-878. [PMID: 30177332 DOI: 10.1016/j.jelectrocard.2018.06.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 06/12/2018] [Indexed: 10/14/2022]
Abstract
Verapamil-sensitive left fascicular monomorphic ventricular tachycardia (LF-VT) was first described ~4 decades ago. Our knowledge regarding this arrhythmia is evolving continuously. The current review aims to highlight up to date aspects of this arrhythmia focusing on its ECG recognition, new considerations of the reentrant circuit, ablation targets in inducible and non-inducible patients and the approach to LF-VT with multiform morphology.
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Affiliation(s)
- Yoav Michowitz
- The Department of Cardiology, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Bernard Belhassen
- The Department of Cardiology, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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5
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Luo B, Zhou G, Guo X, Liu X, Yang J, Sun Q, Ma J, Zhang S. Long-term outcome of catheter ablation for left posterior fascicular ventricular tachycardia with the development of left posterior fascicular block and characteristics of repeat procedures. Int J Cardiol 2017; 236:203-208. [DOI: 10.1016/j.ijcard.2017.01.152] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 01/31/2017] [Indexed: 11/16/2022]
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6
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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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7
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Priori SG, Blomström-Lundqvist C, Mazzanti A, Blom N, Borggrefe M, Camm J, Elliott PM, Fitzsimons D, Hatala R, Hindricks G, Kirchhof P, Kjeldsen K, Kuck KH, Hernandez-Madrid A, Nikolaou N, Norekvål TM, Spaulding C, Van Veldhuisen DJ. 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC)Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC). Europace 2015; 17:1601-87. [PMID: 26318695 DOI: 10.1093/europace/euv319] [Citation(s) in RCA: 217] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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8
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Priori SG, Blomström-Lundqvist C, Mazzanti A, Blom N, Borggrefe M, Camm J, Elliott PM, Fitzsimons D, Hatala R, Hindricks G, Kirchhof P, Kjeldsen K, Kuck KH, Hernandez-Madrid A, Nikolaou N, Norekvål TM, Spaulding C, Van Veldhuisen DJ. 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC). Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC). Eur Heart J 2015; 36:2793-2867. [PMID: 26320108 DOI: 10.1093/eurheartj/ehv316] [Citation(s) in RCA: 2530] [Impact Index Per Article: 281.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
MESH Headings
- Acute Disease
- Aged
- Anti-Arrhythmia Agents/therapeutic use
- Arrhythmias, Cardiac/genetics
- Arrhythmias, Cardiac/therapy
- Autopsy/methods
- Cardiac Resynchronization Therapy/methods
- Cardiomyopathies/complications
- Cardiomyopathies/therapy
- Cardiotonic Agents/therapeutic use
- Catheter Ablation/methods
- Child
- Coronary Artery Disease/complications
- Coronary Artery Disease/therapy
- Death, Sudden, Cardiac/prevention & control
- Defibrillators
- Drug Therapy, Combination
- Early Diagnosis
- Emergency Treatment/methods
- Female
- Heart Defects, Congenital/complications
- Heart Defects, Congenital/therapy
- Heart Transplantation/methods
- Heart Valve Diseases/complications
- Heart Valve Diseases/therapy
- Humans
- Mental Disorders/complications
- Myocardial Infarction/complications
- Myocardial Infarction/therapy
- Myocarditis/complications
- Myocarditis/therapy
- Nervous System Diseases/complications
- Nervous System Diseases/therapy
- Out-of-Hospital Cardiac Arrest/therapy
- Pregnancy
- Pregnancy Complications, Cardiovascular/therapy
- Primary Prevention/methods
- Quality of Life
- Risk Assessment
- Sleep Apnea, Obstructive/complications
- Sleep Apnea, Obstructive/therapy
- Sports/physiology
- Stroke Volume/physiology
- Terminal Care/methods
- Ventricular Dysfunction, Left/complications
- Ventricular Dysfunction, Left/therapy
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9
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Catheter ablation of idiopathic ventricular tachycardia without the use of fluoroscopy. Int J Cardiol 2015; 190:338-43. [PMID: 25935624 DOI: 10.1016/j.ijcard.2015.04.146] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 03/17/2015] [Accepted: 04/16/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Catheter ablation is the treatment of choice for many patients with idiopathic ventricular tachycardia (VT). Unfortunately, conventional catheter ablation is guided by fluoroscopy, which is associated with a small but definite radiation risk for patients and laboratory personnel. The aim of our study is to assess feasibility, success rate and safety of idiopathic VT ablation procedure performed without the use of fluoroscopy. METHODS Nineteen consecutive patients undergoing idiopathic VT ablation at our institution have been included. The ablation procedures were performed under the guidance of electroanatomical mapping (EAM) system and intracardiac echocardiography (ICE). RESULTS Nineteen patients (mean age 38.7 years) underwent ablation procedure for idiopathic VT. Twelve (63%) had outflow tract VT, 3 (18%) fascicular tachycardia, 2 (11%) peri-tricuspidal VT, 1 (5%) peri-mitral VT, and 1 (5%) lateral left free-wall VT. The mean procedural time was 170.2 ± 45.7 min. No fluoroscopy was used in any procedural phase. Acute success rate was 100%. No complication was documented in any patients. After a mean follow up of 18 ± 4 months, recurrences occurred in 2 patients. CONCLUSIONS In our preliminary experience idiopathic VT ablation without the use of fluoroscopy was feasible and safe, using a combination of EAM and ICE. Success rate was excellent with no complication.
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10
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Fishberger SB, Olen MM, Rollinson NL, Rossi AF. Creation of partial fascicular block: an approach to ablation of idiopathic left ventricular tachycardia in the pediatric population. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2014; 38:209-15. [PMID: 25469902 DOI: 10.1111/pace.12551] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Revised: 09/19/2014] [Accepted: 10/25/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Catheter ablation of idiopathic left ventricular tachycardia in the pediatric population remains challenging. A recent multicenter study reported limited success with 14% not undergoing ablation due to inability to induce ventricular tachycardia (VT) or blood pressure instability during tachycardia. Creating complete or partial fascicular block with radiofrequency catheter ablation is a technique that may eliminate VT. This approach is performed during sinus rhythm, enabling atrioventricular conduction monitoring and maintaining stable hemodynamics. Importantly, induction of VT is not necessary for mapping or assessing efficacy of the procedure. METHODS A retrospective review of pediatric patients (3-17 years) with recurrent, documented idiopathic left ventricular tachycardia by electrocardiogram who received catheter ablation by creating fascicular block as a therapeutic endpoint was performed. All had ablation at the site of an identified Purkinje potential. RESULTS There were six patients with idiopathic left ventricular tachycardia, five originating from the posterior fascicle and one from the anterior fascicle. VT was not induced or spontaneous in four patients using programmed stimulation and isoproterenol infusion. All patients had a QRS axis shift following ablation, though none met criteria for fascicular block. At follow up (7-49 months, mean 27 months), all patients had persistence of this shift. There were no recurrences of VT and none of the patients were taking antiarrhythmic medication. CONCLUSION The technique of creating partial fascicular block appears to be a safe and effective approach to ablation of idiopathic left ventricular tachycardia in children.
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Affiliation(s)
- Steven B Fishberger
- Division of Cardiology, Miami Children's Hospital, Miami, Florida; Division of Pediatric Cardiology, Yale-New Haven Medical Center, New Haven, Connecticut
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11
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Nakagawa E, Takagi M, Abe Y, Komatsu R, Haze K, Naruko T, Itoh A. The main trunk of the left bundle branch is not part of the re-entry circuit of verapamil-sensitive idiopathic left ventricular tachycardia. J Arrhythm 2012. [DOI: 10.1016/j.joa.2011.12.001] [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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12
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WISSNER ERIK, MENON SYAMKUMARDIVAKARA, METZNER ANDREAS, SCHOONDERWOERD BAS, NUYENS DIETER, MAKIMOTO HISAKI, ZHANG QINGYING, MATHEW SHIBU, FUERNKRANZ ALEXANDER, RILLIG ANDREAS, TILZ ROLANDRICHARD, KUCK KARLHEINZ, OUYANG FEIFAN. Long-Term Outcome After Catheter Ablation for Left Posterior Fascicular Ventricular Tachycardia Without Development of Left Posterior Fascicular Block. J Cardiovasc Electrophysiol 2012; 23:1179-84. [DOI: 10.1111/j.1540-8167.2012.02377.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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13
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Park J, Kim YH, Hwang C, Pak HN. Electroanatomical characteristics of idiopathic left ventricular tachycardia and optimal ablation target during sinus rhythm: significance of preferential conduction through Purkinje fibers. Yonsei Med J 2012; 53:279-88. [PMID: 22318814 PMCID: PMC3282975 DOI: 10.3349/ymj.2012.53.2.279] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE We hypothesized that Purkinje potential and their preferential conduction to the left ventricle (LV) posteroseptum during sinus rhythm (SR) are part of reentrant circuits of idiopathic left ventricular tachycardia (ILVT) and reentry anchors to papillary muscle. MATERIALS AND METHODS In 14 patients with ILVT (11 men, mean age 31.5±11.1 years), we compared Purkinje potential and preferential conduction during SR with VT by non-contact mapping (NCM). If clear Purkinje potential(SR) was observed in the LV posteroseptum and the earliest activation site (EA) of preferential conduction at SR (EA(SR)) was well matched with that of VT (EA(VT)), EA(SR) was targeted for radiofrequency catheter ablation (RFCA). Also, the anatomical locations of successful ablation sites were evaluated by echocardiography in five additional patients. RESULTS 1) All induced VTs exhibited clear Purkinje potential(VT) and preferential conduction in the LV posteroseptum. The Purkinje potential(VT) and EA(VT) was within 5.8±8.2 mm of EA(SR). However, the breakout sites of VT were separated by 30.2±12.6 mm from EA(VT) to the apical side. 2) Purkinje potential(SR) demonstrated a reversed polarity to Purkinje potential(VT), and the interval of Purkinje potential(SR)-QRS was longer than the interval of Purkinje potential(VT)-QRS (p<0.02) 3) RFCA targeting EA(SR) eliminated VT in all patients without recurrence within 23.3±7.5 months, and the successful ablation site was discovered at the base of papillary muscle in the five additional (100%) patients. CONCLUSION NCM-guided localization of EA(SR) with Purkinje potential(SR) matches well with EA(VT) with Purkinje potential(VT) and provides an effective target for RFCA, potentially at the base of papillary muscle in patients with ILVT.
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Affiliation(s)
- Junbeom Park
- Department of Cardiology, Yonsei University Health System, Seoul, Korea
| | | | - Chun Hwang
- Utah Valley Regional Medical Center, Provo, UT and Krannert Heart Institute, Indiana University, Indianapolis, IN, USA
| | - Hui-Nam Pak
- Department of Cardiology, Yonsei University Health System, Seoul, Korea
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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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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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Abstract
Idiopathic ventricular arrhythmias occur in patients without structural heart disease. They can arise from a variety of specific areas within both ventricles and in the supravalvular regions of the great arteries. Two main groups need to be differentiated: arrhythmias from the outflow tract (OT) region and idiopathic left ventricular, so-called fascicular, tachycardias (ILVTs). OT tachycardia typically originates in the right ventricular OT, but may also occur in the left ventricular OT, particularly in the sinuses of Valsalva or the anterior epicardium or the great cardiac vein. Activation mapping or pace mapping for the OT regions and mapping of diastolic potentials in ILVTs are the mapping techniques that are typically used. The ablation of idiopathic ventricular arrhythmias is highly successful, associated with only rare complications. Newly recognized entities of idiopathic ventricular tachycardias are those originating in the papillary muscles and in the atrioventricular annular regions.
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Affiliation(s)
- Doreen Schreiber
- Department of Electrophysiology, Clinic Hirslanden - Heart Center, Witellikerstrasse 40, CH - 8032, Zurich, Switzerland.
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17
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Lee KT, Chu CS, Dai ZK, Wu JR, Sheu SH, Lai WT. Successful catheter ablation of idiopathic left ventricular tachycardia during sinus rhythm. Int J Cardiol 2007; 115:e74-7. [PMID: 17137659 DOI: 10.1016/j.ijcard.2006.08.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2006] [Accepted: 08/03/2006] [Indexed: 11/29/2022]
Abstract
Successful catheter ablation of idiopathic left ventricular tachycardia (ILVT) can be performed at the site of the earliest Purkinje potential or at the site with recording of diastolic and presystolic Purkinje potentials simultaneously during ventricular tachycardia (VT). However, these critical potentials might be difficult to be recorded and mapped in some patients during VT. It is rare to report the ablation of ILVT during sinus rhythm. We present a case with ILVT who received successful catheter ablation during sinus rhythm.
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Abstract
Idiopathic ventricular tachycardia (VT) is an uncommon form of VT that is seen in patients without structural heart disease. It is commonly seen in young patients and usually has a benign course. Recent studies have delineated the mechanisms and anatomical locations of this form of VT. Recognition of various forms of idiopathic VT based on characteristic QRS morphology from the 12-lead electrocardiogram (ECG) has important prognostic and therapeutic implications. The understanding of the mechanisms of idiopathic VT has led to the use of specific antiarrhythmic drugs targeting particular arrhythmias. Recent technological advances in the field of mapping and catheter ablation have led to a suitable alternative to drug therapy with a very high cure rate. This review describes the clinical features, ECG recognition, and management of idiopathic monomorphic VT.
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