Clinical and electrophysiologic spectrum of fascicular tachycardias

González, Rolando; Scheinman, Melvin M.; Lesh, Michael D.; Helmy, Ibrahim; Torres, Vilma; Hare, George F. Van

doi:10.1016/0002-8703(94)90021-3

Cited by 51 publications

(36 citation statements)

References 8 publications

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“…It is thought to be because of abnormal automaticity in most cases. 7 In our cases, the majority of PVCs/VT could be induced by intravenous isoproterenol or less commonly, atropine infusion or by burst atrial/ventricular pacing, and the induced VT could not be entrained. Although tachycardia induction by burst atrial/ventricular pacing or by using Isoproterenol infusion may indicate triggered activity as an underlying mechanism of NRFT, abnormal automaticity cannot be excluded because NRFT was nonsustained in the majority of the cases in which many maneuvers such as overdrive pacing could not be performed to rule out the presence of abnormal automaticity.…”

Section: Electrophysiological Characteristics Of Idiopathic Nrftmentioning

confidence: 55%

“…Indeed, VT recurrence was observed in 4 patients, 3 of whom had noninducible VT, and pacemap-guided ablation was performed during the first ablation session. Gonzalez et al 7 reported a low success rate of catheter ablation at the exit site (2 successful cases out of 5). In our cohort, 2 cases developed a new VT of a different morphology, suggesting that ablating the exit site, as determined by pacemapping, did not necessarily eliminate the VT origin; instead, it may have only changed the VT exit to an adjacent Purkinje arborization or to the myocardium.…”

Section: Challenges In Idiopathic Nrft Ablationmentioning

confidence: 99%

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Non-Reentrant Fascicular Tachycardia

Talib

Nogami

Morishima

et al. 2016

Circ: Arrhythmia and Electrophysiology

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Reentry is a common mechanism of ventricular tachycardia (VT) that originates from the Purkinje system, and verapamil-sensitive idiopathic left ventricular tachycardia (ILVT) is considered the most common form of Purkinjerelated idiopathic VT.1 Although focal non-reentrant fascicular tachycardia (NRFT) was reported in patients with structural heart diseases involving the Purkinje system, such as those associated with myocardial infarction, 2 little is known about the prevalence, electrophysiological characteristics, or preferential sites of the tachycardia origin of NRFT in patients without structural heart diseases. The purpose of this study was to clarify the aforementioned points with the results of long-term follow-up after radiofrequency catheter ablation (RFCA). Methods Study SampleAmong 530 patients who were referred for RFCA of idiopathic VT, we identified 15 patients (2.8%) with distinct electrocardiographic and electrophysiological characteristics of focal NRFT. The study only included cases of VT, and those with isolated premature ventricular complex (PVC) were excluded. Of note, 17 patients had isolated PVCs of NRF type (14 left posterior fascicle [LPF] origin, 2 left anterior fascicle origin, and 1 right ventricle [RV]-Purkinje origin). For each patient, after a detailed medical history and examination were conducted, structural heart diseases were ruled out by using a standard investigation protocol, which included a 12-lead surface ECG, chest radiography, 2-dimensional (2D) echocardiography, 24-hour Holter recordings, cardiac computed tomography (when appropriate), coronary angiography, and right or left ventriculography. This study was approved by the local ethics committee and all patients provided written informed consent. Electrophysiology Study and the Stimulation ProtocolThe electrophysiology study was performed after obtaining written informed consent from patients, and antiarrhythmic drugs were withdrawn for ≥5 half-lives. Standard multielectrode catheters were placed in the high right atrium, His-bundle region, and RV apex. Programmed atrial and ventricular stimulation was performed © 2016 American Heart Association, Inc. Original Article Circ Arrhythm ElectrophysiolBackground-The most common form of idiopathic Purkinje-related ventricular tachycardia (VT) is the reentrant type. We describe the clinical and electrophysiological characteristics of focal non-reentrant fascicular tachycardia. Methods and Results-Among 530 idiopathic VT patients who were referred for ablation, we identified 15 (2.8%) with non-reentrant fascicular tachycardia (11 men, 45±21 years). Sinus rhythm ECG showed normal conduction intervals with a His-ventricular interval of 41±4 ms. All patients had monomorphic VT (cycle length: 337±88 ms) with a relatively narrow QRS (123±12 ms), and they did not respond to verapamil during the initial presentation. VT exhibited right bundle-branch block/superior axis configuration in 11 patients (73%) and inferior axis in 3 (20%). In 1 patient (7%), VT exhibited left bundle-branch...

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Section: Electrophysiological Characteristics Of Idiopathic Nrftmentioning

confidence: 55%

Section: Challenges In Idiopathic Nrft Ablationmentioning

confidence: 99%

Non-Reentrant Fascicular Tachycardia

Talib

Nogami

Morishima

et al. 2016

Circ: Arrhythmia and Electrophysiology

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“…Malignus formája az idiopathiás kamrafi brilláció (VF), amelyet ugyancsak a Purkinjerendszerben fellépő fokális aktivitás vált ki [38]. Fontos, hogy a fokális Purkinje-VT nem verapamilérzékeny és 12 elvezetéses EKG-n az előbbi verapamilérzékeny csoporttól alig különböztethető meg [39]. Programozott kamrai ingerléssel nem befolyásolható, ellenben terheléssel vagy katecholaminokkal indukálható, és érzékeny lidokain vagy béta-blokkoló terápiára.…”

Section: Fokális Purkinje-vt-kunclassified

“…Itt az ablatio során, a fennálló VT alatt, a legkorábbi Purkinje-potenciál megkeresése a cél. Sinusrhythmus esetén ezen a helyen fúziós Purkinje-potenciálok láthatók [39]. …”

Section: Fokális Purkinje-vt-kunclassified

Kamrai tachycardiák katéterablatiós kezelése

2015

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Az utóbbi két évtizedben a katéterablatiós technológia és az ablatiós stratégiák fejlődésével jelentős előrelépés történt a kamrai tachycardiák ablatiós kezelésében. Jelen összefoglaló közlemény célja a kamrai ritmuszavarok aktuális katé-terablatiós kezelésének áttekintő ismertetése. A szerzők részletezik a katéterablatiós kezelés technikai alapjait, a kamrai tachycardiák ablatiós kezelésének javallatait és ellenjavallatait, a beavatkozás előtti és az azt követő vizsgálatokat. Ezt követően a kamrai tachycardiák csoportosításán keresztül az egyes típusok katéteres ablatiójának jellemzőit ismertetik. Ezzel párhuzamosan kitérnek az adott ritmuszavar kezelésével kapcsolatos eredményekre is. Összegzésképpen kiemelik, hogy a katéteres ablatio sikeresen alkalmazható eszközös beavatkozás a kamrai tachycardiák kezelésében. Megfelelő javallat esetén a kezelést lehetőleg minél korábban be kell iktatni a terápiás stratégiába. Orv. Hetil., 2015, 156(25), 995-1002. Kulcsszavak: kamrai tachycardia, ablatio, elektrofi ziológia Catheter ablation of ventricular tachycardiasCatheter ablation of ventricular tachycardias emerged signifi cantly as standard therapy in the past 20 years. In this review recent advances in catheter ablation of ventricular tachycardias are discussed. The authors fi rst present in details the technical aspects of ablation strategies, main indications and contraindications of ventricular tachycardia ablation and the necessary pre-and postinterventional diagnostic tests. Outcome is also discussed in different forms of ventricular tachycardias in detail. The authors summarize the safety and effi cacy of catheter ablation of ventricular arrhythmias. They recommend that ablation of ventricular tachycardias should be considered earlier in patients with and without structural heart disease. Keywords: ventricular tachycardia, ablation, electrophysiology ÖSSZEFOGLALÓ KÖZLEMÉNYRövidítések ARVC = arrhythmogen jobb kamrai cardiomyopathia; CMP = cardiomyopathia; CT = komputertomográfi a; EAM = elektroanatómiai térképezőrendszer; ECHO = echokardiográfi a; EGM = intracardialis elektrogram; EKG = elektrokardiogram; EP = elektrofi ziológia; ICD = implantálható cardioverter-defi brillátor; ICE = intracardialis ultrahang; LVEF = bal kamrai ejekciós frakció; LVOT = bal kamrai kiáramlási pálya tachycardia; MR = mágneses rezonancia; RF = rádiófrekvenciás; RMN = mágneses navigációs rendszer; RVOT = jobb kamrai kiáramlási pálya tachycardia; VF = kamrafi brilláció; VT = kamrai tachycardia A kamrai tachycardiák (VT) két nagy csoportját külön-böztetjük meg, amelyek patofi ziológia, prognózis és terápia szempontjából jól elkülöníthetők. Az idiopathiás VT-k strukturális szívizombetegséggel nem járó kamrai ritmuszavarok, és ezen csoport mintegy 10-20%-át teszik ki [1]. A VT-k túlnyomó többsége azonban strukturális szívizombetegséggel járó ritmuszavar, amely az előbbinél nagyobb mortalitással jellemezhető [2]. Az elmúlt évtizedekben természetesen mindkét csoport gyógyszeres és utóbb már eszközös terápiás kezelése is az orvostudomány n...

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“…2 Each patient underwent an electrophysiological study and radiofrequency catheter ablation. Antiarrhythmic drugs were stopped at least 48 hours before.…”

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confidence: 99%

Experience with radiofrequency catheter ablation of fascicular tachycardia.

Bennett

1997

Heart

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Results-Radiofrequency ablation was successful in both patients with tachycardia arising from the anterior fascicle and in six of the seven patients with tachycardias arising from the posterior fascicle. Notable differences in the "right bundle branch block" configuration of lead VI during tachycardia between patients were observed. One patient with incessant tachycardia had marked impairment of ventricular function which returned to normal after ablation.Conclusions-Radiofrequency ablation is effective in both anterior and posterior fascicular tachycardias. The arrhythmia can cause reversible impairment of ventricular function.

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Clinical and electrophysiologic spectrum of fascicular tachycardias

Cited by 51 publications

References 8 publications

Non-Reentrant Fascicular Tachycardia

Non-Reentrant Fascicular Tachycardia

Kamrai tachycardiák katéterablatiós kezelése

Experience with radiofrequency catheter ablation of fascicular tachycardia.

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