Bundle branch reentrant tachycardia treated by electrical ablation of the right bundle branch

Touboul, P; Kirkorian, Gilbert; Atallah, G; Lavaud, Pierre; Moleur, P; Lamaud, M; Mathieu, M.

doi:10.1016/s0735-1097(86)80163-2

Cited by 52 publications

(12 citation statements)

References 10 publications

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“…Sosa et al 80–82 developed and successfully used the intrapericardial approach to ablate VT in Chagas disease in which the critical components of the VT circuit commonly were subepicardial. Another reentrant VT initially described in cardiomyopathy and other conditions with severe LV dysfunction was bundle branch reentry 160–163 . This VT circuit most commonly used the RBB anterogradely and the LBB retrogradely, but the reverse also could be seen.…”

Section: Application Of Electrophysiologic Studies and Developed Thermentioning

confidence: 99%

Electrophysiology of Ventricular Tachycardia:

Josephson

2003

Cardiovasc electrophysiol

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Section: Application Of Electrophysiologic Studies and Developed Thermentioning

confidence: 99%

Electrophysiology of Ventricular Tachycardia:

Josephson

2003

Cardiovasc electrophysiol

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“…Two of the patients treated by right bundle ablation also died of progressive congestive heart failure. The mean baseline left ventricular ejection fraction in patients who underwent right bundle ablation and in the remaining 11 A…”

Section: Tachycardia Initiationmentioning

confidence: 99%

Sustained bundle branch reentry as a mechanism of clinical tachycardia.

et al. 1989

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The incidence of sustained bundle branch reentrant (BBR) tachycardia as a clinical or induced arrhythmia or both continues to be underreported. At our institution, BBR has been the underlying mechanism of sustained monomorphic ventricular tachycardia in approximately 6% of patients, whereas mechanisms unrelated to BBR were the cause in the rest. Data gathered from 20 consecutive patients showed electrophysiologic characteristics that suggest this possibility. These include induction of sustained monomorphic tachycardia with typical left or right bundle branch block morphology or both and atrioventricular dissociation or ventriculoatrial block. On intracardiac electrograms, all previously published criteria for BBR were fulfilled, and in addition, whenever there was a change in the cycle length of tachycardia, the His to His cycle length variation produced similar changes in ventricular activation during subsequent complexes with no relation to the preceding ventricular activation cycles. Compared with patients with ventricular tachycardia due to mechanisms unrelated to BBR, patients with BBR had frequent combination of nonspecific intraventricular conduction defects and prolonged HV intervals (100% vs. 11%, p <0.001). When this combination was associated with a tachycardia showing a left bundle branch block pattern, BBR accounted for the majority compared with mechanisms unrelated to BBR (73% vs. 27%, p< 0.01). The above finding in patients with dilated cardiomyopathy should raise the suspicion of sustained BBR because dilated cardiomyopathy was observed in 95% of the patients with BBR. Twelve of the 20 patients were treated with antiarrhythmic agents, and the other eight were managed by selective catheter ablation of the right bundle branch with electrical energy. Our data suggest that sustained BBR is not an uncommon mechanism of tachycardia; it can be induced readily in the laboratory and is amenable to catheter ablation by the very nature of its circuit. The clinical and electrophysiologic features outlined in this study should enable one to correctly diagnose this important arrhythmia. (Circulation 1989;79:256-270) M acroreentry within the His-Purkinje system commonly referred to as bundle branch reentry (BBR) is a frequently observed phenomenon in the laboratory.1-3Although scattered cases of sustained BBR tachycardia have been reported, no large series dealing with this phenomenon exists in the literature.4-11 The incidence of BBR as a mechanism of sustained ventricular tachycardia (VT), therefore, continues to be underreported in the literature, and consequently, there is less awareness of sustained BBR tachycardia as a significant clinical arrhythmia.

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“…Idiopathische VT, VT aus dem rechts-(RVOT) oder linksventrikulären Ausflusstrakt (LVOT) [10], idiopathische linksventrikuläre Tachykardien [11,12] und BBR-Tachykardien [13,14] sind prinzipiell durch eine Ablationsbehandlung kurierbar.…”

Section: Idiopathische Ventrikuläre Und Bundlebranch-reentrytachykardienunclassified

Voraussetzungen der ICD-Implantation

Bänsch

Antz

2005

Herz

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An electrophysiological study (EPS) and a programmed ventricular stimulation (PVS) are strongly recommended and clearly indicated before the implantation of a cardioverter defibrillator (ICD), if patients present with a cardiac arrest and no structural heart disease or a hypertrophic cardiomyopathy. In these patients the prevalence of a curable cause of the cardiac arrest, such as accessory pathways or an idiopathic ventricular tachycardia (VT), is high and the ICD implantation may be avoided. The same is true for patients who present with a cardiac arrest and a short PQ interval or a delta wave. If patients present with wide-complex tachycardias and the diagnosis of VT is unclear, an EPS and PVS are also clearly indicated. If patients have syncope or nonsustained VTs and a structural heart disease, PVS may be used for risk stratification. However, EPS and PVS may be of little use in patients with a structural heart disease and an impaired left ventricular function after a survived cardiac arrest or an unstable VT, which makes them candidates for ICD implantation anyway.

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Bundle branch reentrant tachycardia treated by electrical ablation of the right bundle branch

Cited by 52 publications

References 10 publications

Electrophysiology of Ventricular Tachycardia:

Electrophysiology of Ventricular Tachycardia:

Sustained bundle branch reentry as a mechanism of clinical tachycardia.

Voraussetzungen der ICD-Implantation

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