Transcatheter electrical ablation of right bundle branch. A method of treating macroreentrant ventricular tachycardia attributed to bundle branch reentry.

Tchou, Patrick; Jazayeri, Mohammad; Denker, Stephen; Dongas, John; Cáceres, José Alberto González; Akhtar, Masood

doi:10.1161/01.cir.78.2.246

Cited by 179 publications

(42 citation statements)

References 12 publications

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“…W 12-odprowadzeniowym powierzchniowym EKG widać morfologię LBBB z odchyleniem osi elektrycznej w lewo. Reentry z odnóg pęczka Hisa często wiąże się z kardiomiopatią [347]. Wyleczenie umożliwia ablacja przezcewnikowa jednej z odnóg pęczka Hisa, a preferowanym celem jest prawa odnoga, ponieważ jest ona łatwiej dostępna do ablacji [347].…”

Section: Częstoskurcz Nawrotny Z Odnóg Pęczka Hisaunclassified

“…Wyleczenie umożliwia ablacja przezcewnikowa jednej z odnóg pęczka Hisa, a preferowanym celem jest prawa odnoga, ponieważ jest ona łatwiej dostępna do ablacji [347]. Ponieważ nieprawidłowość strukturalna leżąca u podłoża arytmii pozostaje niezmieniona, to należy zdecydowanie rozważyć jednoczesne wszczepienie ICD [347].…”

Section: Częstoskurcz Nawrotny Z Odnóg Pęczka Hisaunclassified

“…Częstoskurcz nawrotny z odnóg pęczka Hisa stwierdza się zwykle u pacjentów z uprzednio występującymi zaburzeniami przewodzenia wewnątrzkomorowego, takimi jak wydłużenie odstępu HV lub blok odnogi pęczka Hisa [346,347,574]. Częstoskurcz nawrotny z odnóg pęczka Hisa poddaje się ablacji przezcewnikowej w obrębie lewej odnogi lub częściej prawej odnogi pęczka Hisa, przynajmniej w doświadczonych ośrodkach, która często eliminuje możliwość wywołania częstoskurczu, co można uznać za wyleczenie z arytmii [346,347,575].…”

Section: Idiopatyczny Częstoskurcz Z Lewej Komoryunclassified

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2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death

Priori

Blomström‐Lundqvist²,

Mazzanti³

et al. 2015

Kardiol Pol

233

337

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Section: Częstoskurcz Nawrotny Z Odnóg Pęczka Hisaunclassified

Section: Idiopatyczny Częstoskurcz Z Lewej Komoryunclassified

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2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death

Priori

Blomström‐Lundqvist²,

Mazzanti³

et al. 2015

Kardiol Pol

233

337

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“…Percutaneous catheter ablation of the right bundle was successfully performed in the remaining eight patients, and not a single beat of BBR could be induced after right bundle ablation in these patients. 15 Follow-up period ranged from 6 to 2,985 days with a mean of 614±847 days. Eleven of the 12 patients who received antiarrhythmic agents were still taking these drugs at the time of death or follow-up.…”

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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“…1,2 Recognition or exclusion of BBR, however, can be challenging and timeconsuming. [3][4][5][6] Criteria based on the recording of the His bundle electrogram have several limitations, such as failure to record the His bundle electrogram during tachycardia because of catheter displacement or severe His-Purkinje disease, [3][4][5][6][7] and BBR nonrecognition when oscillations in the VV interval precede those of the HH interval because of conduction variations in the antegrade, rather than the retrograde, conducting bundle branch.…”

mentioning

confidence: 99%

Bundle-Branch Reentry and the Postpacing Interval After Entrainment by Right Ventricular Apex Stimulation

Merino¹,

Peinado²,

Fernández‐Lozano³

et al. 2001

Circulation

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Background-Diagnosis of bundle-branch reentry ventricular tachycardia (BBR-VT) by the standard approach is challenging, and this may lead to nonrecognition of this tachycardia mechanism. Because the postpacing interval (PPI) after entrainment has been correlated with the distance from the pacing site to the reentrant circuit, BBR-VT entrainment by pacing from the right ventricular apex (RVA) should result in a PPI similar to the tachycardia cycle length (TCL). This factor may differentiate BBR-VT from other mechanisms of wide-QRS-complex tachycardia with AV dissociation, such as myocardial reentrant VT (MR-VT) or AV nodal reentrant tachycardia (AVNRT), in which the circuit is usually located away from the RVA. Methods and Results-Transient entrainment by RVA pacing was attempted in 18 consecutive BBR-VTs and finally achieved in 13. Results were compared with those found in 59 consecutive MR-VTs and 50 consecutive AVNRTs. The mean PPIϪTCL difference was significantly (PϽ0.0001) shorter in the BBR-VT group (9Ϯ11 ms) than in the MR-VT (109Ϯ48 ms) and the AVNRT (150Ϯ29 ms) groups. No BBR-VT showed a PPIϪTCL Ͼ30 ms (range Ϫ12 to 24 ms). Except for 2 MR-VTs, no MR-VT (range 21 to 211 ms) or AVNRT (range 100 to 215 ms) showed a PPIϪTCL Ͻ30 ms. Conclusions-A PPIϪTCL Ͼ30 ms, after entrainment by RVA stimulation, makes BBR-VT unlikely. Conversely, a PPIϪTCL Ͻ30 ms is suggestive of BBR-VT but should lead to further investigation by use of conventional criteria.

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Transcatheter electrical ablation of right bundle branch. A method of treating macroreentrant ventricular tachycardia attributed to bundle branch reentry.

Cited by 179 publications

References 12 publications

2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death

2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death

Sustained bundle branch reentry as a mechanism of clinical tachycardia.

Bundle-Branch Reentry and the Postpacing Interval After Entrainment by Right Ventricular Apex Stimulation

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