Idiopathic verapamil-responsive left ventricular tachycardia: clinical characteristics and long-term follow-up of 33 patients

Gaïta, Fiorenzo; Giustetto, Carla; Leclercq, J. F.; Haı̈ssaguerre, Michel; Riccardi, Riccardo; Libero, L; Baralis, Giorgio; Brusca, A; Coumel, Philippe; Warin, J F

doi:10.1093/oxfordjournals.eurheartj.a060661

Cited by 31 publications

(18 citation statements)

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“…6,[8][9][10] The QRS morphology is only moderately widened during ventricular tachycardia and is narrower than that of other VTs. 11) It occurs primarily at rest, but may be induced by exercise. The symptoms and signs during tachycardia include palpitations, dizziness, presyncope, syncope, or no symptoms.…”

Section: Discussionmentioning

confidence: 99%

Verapamil Sensitive Idiopathic Ventricular Tachycardia in an Infant

Wang

Jan

et al. 2003

Jpn Heart J

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SUMMARYIdiopathic ventricular tachycardia is rare, especially in infants. We report here on an 8month-old female infant who presented with tachycardia with a heart rate of 186 beats/ min. An electrocardiogram showed a right bundle branch block pattern, a QRS duration of 80 msec, a superior QRS axis, atrioventricular dissociation, and occasional fusion and capture beats. Suspected ventricular tachycardia was treated with lidocaine, propranolol and amiodarone, but in vain. The tachycardia was terminated and well controlled with the use of verapamil. According to an electrocardiogram and her clinical response, verapamilsensitive idiopathic ventricular tachycardia was diagnosed with the arrhythmic origin in the left posterior fascicle. (Jpn Heart J 2003; 44: 667-671)

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Section: Discussionmentioning

confidence: 99%

Verapamil Sensitive Idiopathic Ventricular Tachycardia in an Infant

Wang

Jan

et al. 2003

Jpn Heart J

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“…The right bundle branch block seen on the resting ECG is a common finding in cardiac transplant patients and is of no prognostic significance 4. The efficacy of verapamil and the potential for successful treatment with radiofrequency ablation in this type of ventricular tachycardia is well recognised 5…”

Section: Discussionmentioning

confidence: 99%

Radiofrequency ablation of a fascicular tachycardia after orthotopic cardiac transplantation

Clarke

Mason²,

Paul³

1998

Heart

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A 51 year old male received an orthotopic transplant because of end stage ischaemic heart disease. The donor was a healthy male teenager with no history of arrhythmias or other cardiac conditions. The patient presented with haemodynamically stable tachycardia and dyspnoea five weeks post-transplant. The ECG showed a regular tachycardia of 140 beats/min with a right bundle branch block morphology, left axis deviation, and a QRS duration of 135 ms. There were independent P waves, capture, and fusion beats confirming the diagnosis of ventricular tachycardia. Endomyocardial biopsy showed moderate focal rejection that was thought to be responsible for the arrhythmia. During the following six months the patient had recurrent tachyarrhythmias; on each occasion the ECG morphology was the same and there was no cellular rejection. The patient continued to have frequent hospital admissions with ventricular tachycardia requiring DC cardioversion despite the empirical use of amiodarone, sotalol, disopyramide, and procainamide. Eighteen months after transplantation the diagnosis of fascicular tachycardia was suspected by ECG morphology and supported by successful termination with intravenous verapamil. The arrhythmia was successfully managed by radiofrequency ablation. This patient shows that arrhythmias following transplantation are not always related to rejection, and that other potentially reversible causes should be considered, particularly when the ECG during arrhythmia conforms to a classic configuration. (Heart 1998;79:414-416) Keywords: radiofrequency ablation; tachyarrhythmias; transplantationThe development of tachyarrhythmias in cardiac transplant patients is often taken as a possible indication of the development of acute rejection, but this is not necessarily the case. We describe a case of fascicular tachycardia after orthotopic cardiac transplantation and its successful management by radiofrequency ablation. Case historyThe patient was a 51 year old man who had received an orthotopic transplant because of end stage ischaemic heart disease. The donor was a healthy male teenager with no history of arrhythmias or other cardiac conditions and a normal resting electrocardiogram (ECG). The total ischaemic time of the donor heart was 4 hours and 40 minutes. Postoperative recovery was uneventful and the patient received routine immunosuppression with cyclosporin and azathioprine.The baseline ECG during sinus rhythm had a right bundle branch block configuration and right axis deviation with a QRS duration of 135 ms ( fig 1A).The patient presented with haemodynamically stable tachycardia and dyspnoea five weeks post-transplant. The ECG showed a regular tachycardia of 140 beats/min with a right bundle branch block morphology, left axis deviation, and a QRS duration of 135 ms. There were independent P waves, capture, and fusion beats (fig 1B) confirming the diagnosis of ventricular tachycardia. His biochemical profile was normal and echocardiography confirmed good ventricular function with an ejection fraction o...

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“…Similar to outflow tract VTs, the long-term prognosis of patients who have idiopathic left VT is excellent [80]. Patients with significant symptoms can be successfully treated acutely with intravenous verapamil and chronically with verapamil, but medical therapy is usually ineffective in most patients who have significant symptoms [77].…”

Section: Managementmentioning

confidence: 99%

Catheter ablation of ventricular tachycardia in structurally normal hearts

Ghanbari

Schmidt

Machado

et al. 2010

Expert Review of Cardiovascular Therapy

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Ventricular tachycardia (VT) in patients without structural heart disease can be observed in 10% of patients presenting with ventricular arrhythmias. These VTs are characterized by QRS morphology, ventricular origin and their response to pharmacologic agents. It is essential to rule out structural heart disease in this population as this can significantly alter the management and the long-term prognosis. These VTs generally have a benign course and therapeutic options are aimed at relieving symptoms related to the arrhythmia. Medical therapy is effective in many patients and radiofrequency offers a cure to those who are refractory to medical therapy. Careful attention to the electrocardiogram can help localize the origin of the VTs, which is crucial when planning an ablation strategy.

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Idiopathic verapamil-responsive left ventricular tachycardia: clinical characteristics and long-term follow-up of 33 patients

Cited by 31 publications

References 1 publication

Verapamil Sensitive Idiopathic Ventricular Tachycardia in an Infant

Verapamil Sensitive Idiopathic Ventricular Tachycardia in an Infant

Radiofrequency ablation of a fascicular tachycardia after orthotopic cardiac transplantation

Catheter ablation of ventricular tachycardia in structurally normal hearts

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