Differentiation of Papillary Muscle From Fascicular and Mitral Annular Ventricular Arrhythmias in Patients With and Without Structural Heart Disease

Al’Aref, Subhi J.; Ip, James E.; Markowitz, Steven M.; Liu, Christopher F.; Thomas, George; Frenkel, Daniel; Panda, Nikhil; Weinsaft, Jonathan W.; Lerman, Bruce B.; Cheung, Jim W.

doi:10.1161/circep.114.002619

Cited by 80 publications

(67 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…21 However, one electrocardiographic clue to assist in differentiating these arrhythmias may be the QRS duration during arrhythmias. 22 Previous studies reported that PM ventricular arrhythmias were distinguished by longer QRS durations. On the contrary, the mean QRS width of PM-FVT in this study was 125±6 ms, which is much narrower than that of PM ventricular arrhythmias.…”

Section: Differentiation From Ventricular Arrhythmias Originating Fromentioning

confidence: 99%

Fascicular Ventricular Tachycardia Originating From Papillary Muscles

Komatsu

Nogami

Kurosaki

et al. 2017

Circ: Arrhythmia and Electrophysiology

View full text Add to dashboard Cite

Using data from a multicenter study that included 144 patients undergoing an electrophysiological study of left FVT, we identified 13 patients (9%) in whom sustained FVT was successfully eliminated by ablation of the Purkinje potentials around the posterior PM (n=8; PPM-FVT) and anterior PM (n=5; APM-FVT). Patients © 2017 American Heart Association, Inc. Original ArticleBackground-Verapamil-sensitive fascicular ventricular tachycardia (FVT) has been demonstrated to be a reentrant mechanism using the Purkinje network as a part of its reentrant circuit. Although the papillary muscles (PMs) are implicated in arrhythmogenic structure, reentrant FVT originating from the PMs has not been well defined. Methods and Results-We studied 13 patients in whom FVT was successfully eliminated by ablation at the posterior PMs (n=8; PPM-FVT) and anterior PMs (n=5; APM-FVT). Although intravenous administration of verapamil (5 mg) terminated ventricular tachycardia (VT) in 6 patients, VT was only slowed in the remaining 7 patients. PPM-FVT exhibited right bundle branch block and superior right axis (extreme right axis) or horizontal axis deviation. APM-FVT exhibited right bundle branch block configuration and right axis deviation with deep S wave in leads I, V 5 , and V 6 . VT was reproducibly induced by programmed atrial or ventricular stimulation. His-ventricular interval during VT was shorter than that during sinus rhythm. Ablation at the left posterior or anterior fascicular regions often changed the QRS morphology but did not completely eliminate it. Mid-diastolic Purkinje potentials were recorded during VT around the PMs, where ablation successfully eliminated the tachycardia. All patients have been free from recurrent VT after ablation. Conclusions-Reentrant circuit of verapamil-sensitive FVT can involve the Purkinje network lying around the PMs. PM-FVT is a distinct entity that is characterized by distinctive electrocardiographic characteristics and less sensitivity to verapamil administration compared with common type FVT. Ablation targeting the mid-diastolic Purkinje potentials around the PMs during tachycardia can be effective in suppressing this arrhythmia. (Circ Arrhythm Electrophysiol.

show abstract

Section: Differentiation From Ventricular Arrhythmias Originating Fromentioning

confidence: 99%

Fascicular Ventricular Tachycardia Originating From Papillary Muscles

Komatsu

Nogami

Kurosaki

et al. 2017

Circ: Arrhythmia and Electrophysiology

View full text Add to dashboard Cite

show abstract

“…Features suggestive of fascicular VT include a QRS duration of less than 130 ms and an rsR′ pattern in V1. 25 Fascicular VT is also associated with a qR or qRs pattern in I, or a VL. Posterior fascicular VT is associated with a small R wave in lead III.…”

Section: Surface Electrocardiogrammentioning

confidence: 99%

Ventricular Arrhythmia Originating from the Left Ventricular Papillary Muscles: Clinical Features and Technical Aspects

Donnelly¹,

Patel²,

Beldner³

2018

J Innov Cardiac Rhythm Manage

View full text Add to dashboard Cite

Section: Differential Diagnosis Of Nrftmentioning

confidence: 99%

“…Moreover, the presence of a V1 r<R′ pattern in the majority of our NRFT cases may support the diagnosis of fascicular arrhythmia as opposed to papillary muscle VT, as suggested by others. 11 In the electrophysiology laboratory, high-frequency Purkinje potentials are usually absent at the site of origin of papillary muscle VT. 10 However, this is not the case when Purkinje fibers are distributed at the surface of papillary muscles. Furthermore, unlike NRFT, papillary muscle VT usually originates somewhere deep relative to the Figure 4 Continued.…”

Section: Talib Et Al Non-reentrant Fascicular Tachycardiamentioning

confidence: 99%

Non-Reentrant Fascicular Tachycardia

Talib

Nogami

Morishima

et al. 2016

Circ: Arrhythmia and Electrophysiology

View full text Add to dashboard Cite

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...

show abstract

Differentiation of Papillary Muscle From Fascicular and Mitral Annular Ventricular Arrhythmias in Patients With and Without Structural Heart Disease

Cited by 80 publications

References 11 publications

Fascicular Ventricular Tachycardia Originating From Papillary Muscles

Fascicular Ventricular Tachycardia Originating From Papillary Muscles

Ventricular Arrhythmia Originating from the Left Ventricular Papillary Muscles: Clinical Features and Technical Aspects

Non-Reentrant Fascicular Tachycardia

Contact Info

Product

Resources

About