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Hwang J, Nam GB, Kim JH, Kim J, Choi KJ, Kim YH. Upper turnaround point in a reentry circuit of the idiopathic left posterior fascicular ventricular tachycardia. Pacing Clin Electrophysiol 2024; 47:300-311. [PMID: 38151978 DOI: 10.1111/pace.14905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/20/2023] [Accepted: 12/05/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND The anatomic extent of the reentry circuit in idiopathic left posterior fascicular ventricular tachycardia (LPF-VT) is yet to be fully elucidated. We hypothesized that entrainment mapping could be used to delineate the reentry circuit of an LPF-VT, especially including the upper turnaround point. METHODS Twenty-three consecutive LPF-VT patients (mean age, 29 ± 9 years, 18 males) were included. We performed overdrive pacing with entrainment attempts at the left bundle branch (LBB) and the left His bundle (HB) region. RESULTS Overdrive pacing from the LBB region showed concealed fusion in all 23 patients (post-pacing interval [PPI], 322.1 ± 64.3 ms; tachycardia cycle length [TCL], 319.0 ± 61.6 ms; PPI-TCL, 3.1 ± 4.6 ms) with a long stimulus-to-QRS interval (287.9 ± 58.0 ms, approximately 90% of the TCL). Pacing from the same LBB region at a slightly faster pacing rate showed manifest fusion with antidromic conduction to the LBB and minimal in-and-out time to the LBB potential (PPI-TCL, 21.3 ± 13.7 ms). Overdrive pacing from the left HB region showed manifest fusion with a long PPI-TCL (53.9 ± 22.5 ms). CONCLUSIONS Our pacing study results suggest that the upper turnaround point in a reentry circuit of the LPF-VT may extend to the proximal His-Purkinje conduction system near the LBB region but below the left HB region. The LPF may constitute the retrograde limb of the reentry circuit.
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Affiliation(s)
- Jongmin Hwang
- Department of Internal Medicine, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Pusan National University, School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
- Keimyung University, School of Medicine, Keimyung University Dongsan Hospital, Daegu, Republic of Korea
| | - Gi-Byoung Nam
- Department of Internal Medicine, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - June Hong Kim
- Pusan National University, School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Jun Kim
- Department of Internal Medicine, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kee-Joon Choi
- Department of Internal Medicine, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - You-Ho Kim
- Department of Internal Medicine, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Liu Q, Wang Y, Ehdaie A, Cheng H, Jiang R, Chen S, Sun Y, Zhang P, Yu L, Sheng X, Lin J, Zhang Z, Zhou X, Fu G, Shehata M, Jiang C, Wang X. False Tendons in the Left Ventricle: Implications for Successful Ablation of Left Posterior Fascicular Tachycardias. JACC Clin Electrophysiol 2023; 9:1914-1929. [PMID: 37480871 DOI: 10.1016/j.jacep.2023.05.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 05/05/2023] [Accepted: 05/12/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND The anatomical substrate for left posterior fascicular ventricular tachycardia (LPF-VT) is still unclear. OBJECTIVES The purpose of this study is to describe the endocavitary substrate of the re-entrant loop of LPF-VT. METHODS A total of 26 consecutive patients with LPF-VT underwent an electrophysiology study and radiofrequency ablation. RESULTS Intracardiac echocardiography imaging observed a 100% prevalence of false tendons (FTs) at the left posterior septal region in all patients, and 3 different types of FTs could be classified according to their location. In 22 patients, a P1 potential could be recorded via the multielectrode catheter from a FT. In 4 patients without a recorded P1 during LPF-VT, the earliest P2 potentials were recorded from a FT in 3 patients, and from a muscular connection between 2 posteromedial papillary muscles in 1 patient. Catheter ablation focused on the FTs with P1 or earliest P2 (in patients without P1) was successful in all 26 patients. After 19 ± 8.5 months of follow-up, no patients had recurrence of LPF-VT. CONCLUSIONS FTs provide an electroanatomical substrate for LPF-VT and a "culprit FT" may be identified as the critical structure bridging the macro-re-entrant loop. Targeting the "culprit FT" is a novel anatomical ablation strategy that results in long-term arrhythmia-free survival.
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Affiliation(s)
- Qiang Liu
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Zhejiang, People's Republic of China
| | - Yunhe Wang
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Zhejiang, People's Republic of China
| | - Ashkan Ehdaie
- Cedars Sinai Heart Institute, Los Angeles, California, USA
| | - Hui Cheng
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Zhejiang, People's Republic of China
| | - Ruhong Jiang
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Zhejiang, People's Republic of China
| | - Shiquan Chen
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Zhejiang, People's Republic of China
| | - Yaxun Sun
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Zhejiang, People's Republic of China
| | - Pei Zhang
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Zhejiang, People's Republic of China
| | - Lu Yu
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Zhejiang, People's Republic of China
| | - Xia Sheng
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Zhejiang, People's Republic of China
| | - Jianwei Lin
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Zhejiang, People's Republic of China
| | - Zuwen Zhang
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Zhejiang, People's Republic of China
| | - Xu Zhou
- Department of Cardiology, Yan'an Hospital of Kunming City, Yunnan, People's Republic of China
| | - Guosheng Fu
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Zhejiang, People's Republic of China
| | | | - Chenyang Jiang
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Zhejiang, People's Republic of China.
| | - Xunzhang Wang
- Cedars Sinai Heart Institute, Los Angeles, California, USA
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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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Liu Q, Shehata M, Jiang R, Yu L, Chen S, Zhu J, Ehdaie A, Sovari AA, Cingolani E, Chugh SS, Jiang C, Wang X. Macroreentrant Loop in Ventricular Tachycardia From the Left Posterior Fascicle. Circ Arrhythm Electrophysiol 2016; 9:CIRCEP.116.004272. [DOI: 10.1161/circep.116.004272] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 06/30/2016] [Indexed: 01/14/2023]
Abstract
Background—
The underlying mechanisms of reentry during left posterior fascicular ventricular tachycardia (LPF-VT) remain unclear. The purpose of this study is to describe the components of LPF-VT reentry circuit and their electrophysiological properties.
Methods and Results—
Fourteen consecutive patients with LPF-VT underwent electrophysiology study and radiofrequency ablation. Via a multipolar electrode catheter placed from a retrograde aortic approach, a sharp inflection, high-frequency potential (P1) was detected in 9 patients (64%). The ranges of length and velocity of recorded P1 were 9 to 30 mm and 0.5 to 1.2 mm/ms, respectively. Macroreentry involving the ventricular myocardium was confirmed to be the mechanism in all patients by premature ventricular stimuli delivery or entrainment of LPF-VT with progressive fusion, or both. During LPF-VT, the earliest left posterior fascicle (LPF, P2) was considered to be the site of connection between P1 and P2, and the site of the earliest P2 along the left posterior ventricular septum correlated well with the His-ventricular interval during tachycardia. Radiofrequency ablation focused on the P1 potentials (9 patients with a recorded P1) or earliest P2 (5 patients without a recorded P1) was successful in all 14 patients. After 4.5±3.0 months of follow-up, no patients had recurrence of LPF-VT.
Conclusions—
The LPF-VT macroreentrant loop involves the ventricular myocardium, a part of the LPF, a slow conduction zone, and in certain cases, a specially conducting P1 fiber. The His-ventricular interval during LPF-VT correlates with multiple electrophysiological measures and is a useful marker for identification of the optimal ablation site.
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Affiliation(s)
- Qiang Liu
- From the Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Zhejiang, P.R. China (Q.L., R.J., L.Y., S.C., J.Z., C.J.); and Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA (Q.L., M.S., A.E., A.A.S., E.C., S.S.C., X.W.)
| | - Michael Shehata
- From the Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Zhejiang, P.R. China (Q.L., R.J., L.Y., S.C., J.Z., C.J.); and Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA (Q.L., M.S., A.E., A.A.S., E.C., S.S.C., X.W.)
| | - Ruhong Jiang
- From the Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Zhejiang, P.R. China (Q.L., R.J., L.Y., S.C., J.Z., C.J.); and Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA (Q.L., M.S., A.E., A.A.S., E.C., S.S.C., X.W.)
| | - Lu Yu
- From the Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Zhejiang, P.R. China (Q.L., R.J., L.Y., S.C., J.Z., C.J.); and Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA (Q.L., M.S., A.E., A.A.S., E.C., S.S.C., X.W.)
| | - Shiquan Chen
- From the Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Zhejiang, P.R. China (Q.L., R.J., L.Y., S.C., J.Z., C.J.); and Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA (Q.L., M.S., A.E., A.A.S., E.C., S.S.C., X.W.)
| | - Jun Zhu
- From the Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Zhejiang, P.R. China (Q.L., R.J., L.Y., S.C., J.Z., C.J.); and Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA (Q.L., M.S., A.E., A.A.S., E.C., S.S.C., X.W.)
| | - Ashkan Ehdaie
- From the Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Zhejiang, P.R. China (Q.L., R.J., L.Y., S.C., J.Z., C.J.); and Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA (Q.L., M.S., A.E., A.A.S., E.C., S.S.C., X.W.)
| | - Ali A. Sovari
- From the Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Zhejiang, P.R. China (Q.L., R.J., L.Y., S.C., J.Z., C.J.); and Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA (Q.L., M.S., A.E., A.A.S., E.C., S.S.C., X.W.)
| | - Eugenio Cingolani
- From the Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Zhejiang, P.R. China (Q.L., R.J., L.Y., S.C., J.Z., C.J.); and Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA (Q.L., M.S., A.E., A.A.S., E.C., S.S.C., X.W.)
| | - Sumeet S. Chugh
- From the Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Zhejiang, P.R. China (Q.L., R.J., L.Y., S.C., J.Z., C.J.); and Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA (Q.L., M.S., A.E., A.A.S., E.C., S.S.C., X.W.)
| | - Chenyang Jiang
- From the Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Zhejiang, P.R. China (Q.L., R.J., L.Y., S.C., J.Z., C.J.); and Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA (Q.L., M.S., A.E., A.A.S., E.C., S.S.C., X.W.)
| | - Xunzhang Wang
- From the Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Zhejiang, P.R. China (Q.L., R.J., L.Y., S.C., J.Z., C.J.); and Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA (Q.L., M.S., A.E., A.A.S., E.C., S.S.C., X.W.)
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