Findings on magnetic resonance imaging of fascicular ventricular tachycardia

Herkommer, Bernhard; Fiek, Michael; Reithmann, Christopher

doi:10.1007/s10840-013-9850-2

Cited by 6 publications

(3 citation statements)

References 18 publications

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“…The essence of the slow conduction zone is unknown but may be some ventricular myocardium or abnormal Purkinje fiber with decremental conduction properties. Herkommer et al 7 reported local areas of fibrosis or scar corresponded to the successful ablation sites of LPF-VT in 3 of 9 patients seen via magnetic resonance imaging. In certain LPF-VT cases, myocardial scar may represent an alternative reason for the presence of a slow conduction zone.…”

Section: Property Of P1 and Slow Conduction Zonementioning

confidence: 99%

Macroreentrant Loop in Ventricular Tachycardia From the Left Posterior Fascicle

Liu

Shehata

Jiang

et al. 2016

Circ: Arrhythmia and Electrophysiology

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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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Section: Property Of P1 and Slow Conduction Zonementioning

confidence: 99%

Macroreentrant Loop in Ventricular Tachycardia From the Left Posterior Fascicle

Liu

Shehata

Jiang

et al. 2016

Circ: Arrhythmia and Electrophysiology

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“…Although classically regarded as a ‘normal heart arrhythmia’, recent studies have demonstrated focal myocardial abnormalities on imaging and association with SHD and myocardial ischaemia 38. The VT may be incessant and can be difficult to suppress with medications.…”

Section: Non-inherited Vt In Structurally Normal Heartsmentioning

confidence: 99%

Ventricular tachycardia in the absence of structural heart disease

Killu

Stevenson

2018

Heart

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“…Cardiac MRI was performed in our institution in 47 patients and in other institutions in 11 patients. In most patients, DE‐MRI was performed before ablation.…”

Section: Methodsmentioning

confidence: 99%

Magnetic resonance imaging abnormalities in the basal interventricular septum of patients with left ventricular outflow tract arrhythmias

Reithmann

Kling

Herkommer

et al. 2019

Cardiovasc electrophysiol

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Introduction: Concealed structural abnormalities were detected by delayed enhancementmagnetic resonance imaging (DE-MRI) in patients with apparently idiopathic tachycardia of left ventricular (LV) origin. Basal septal fibrosis was evaluated as a potential arrhythmia substrate in patients with left ventricular outflow tract (LVOT) arrhythmias. Methods and Results: A total of 22 patients with LVOT arrhythmias, including frequent monomorphic premature ventricular complexes (PVCs) in 15 patients and ventricular tachycardia (VT) in 7 patients, underwent catheter ablation and DE-MRI. A total of 19 patients with frequent PVCs and 17 patients with idiopathic VT of other origin served as a control group. Basal septal intramural fibrosis as thin strip-shaped intramyocardial DE or as marked intramyocardial DE involving >25% of wall thickness was detected more frequently in patients with LVOT arrhythmias (41% and 32%) than in patients with non LVOT arrhythmias (14% and 3%). After successful ablation, 4/16 patients with basal septal intramural fibrosis and LVOT PVCs (n = 3) or LVOT VT (n = 1) compared with no patient without basal septal fibrosis experienced episodes of sustained VT with similar or different QRS morphology resulting in ICD therapy in three patients. Follow-up DE-MRI after PVC ablation (17 ± 7 months)revealed an increase in LV ejection fraction from 49 ± 5% to 56 ± 5% (n = 9) but the amount of septal DE remained unchanged.Conclusions: Basal septal intramural fibrosis may serve as the arrhythmia substrate in a substantial part of patients with premature ventricular complexes (PVCs) and VT originating from the LVOT and identifies patients with continued risk for VT recurrence after initially successful ablation of LVOT arrhythmias. K E Y W O R D S delayed enhancement (DE), left ventricular outflow tract (LVOT), magnetic resonance imaging (MRI), premature ventricular contraction (PVC), ventricular tachycardia (VT)

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Findings on magnetic resonance imaging of fascicular ventricular tachycardia

Abstract: Detection of local areas of fibrosis or scar by DE-MRI may help to distinguish idiopathic fascicular tachycardia from scar-related fascicular VT in patients with preserved left ventricular function.

Cited by 6 publications

References 18 publications

Macroreentrant Loop in Ventricular Tachycardia From the Left Posterior Fascicle

Macroreentrant Loop in Ventricular Tachycardia From the Left Posterior Fascicle

Ventricular tachycardia in the absence of structural heart disease

Magnetic resonance imaging abnormalities in the basal interventricular septum of patients with left ventricular outflow tract arrhythmias

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