Verapamil Sensitive Idiopathic Ventricular Tachycardia in an Infant

Abstract

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)

Induction of Left Ventricular Fascicular Tachycardia with Transesophageal Pacing in a Toddler

“…Although TEEPS has previously been reported in adult patients to induce LVVT, 7,8 this is the first case of induction of LVVT during a TEEPS in a toddler. Furthermore, in contrast to the other case reports, 4–6 this patient had recurrence of his tachycardia requiring radiofrequency catheter ablation. We feel that after a patient has been treated for LVVT for an appropriate time period, one should consider a TEEPS, a simple, rapid, and noninvasive method to confirm that the VT has resolved before discontinuing medication.…”

“…This case is unique when compared with the previously reported cases of verapamil‐sensitive VT in pediatric patients 4–6 . While the early clinical courses—resistance to multiple antiarrhythmic drugs, failed cardioversion, restoration of sinus rhythm with atrial overdrive pacing, and control of tachycardia with verapamil—were similar, the long‐term outcome differed significantly in this patient.…”

“…This patient had a right bundle branch block superior axis VT consistent with LVVT. This diagnosis in infants and toddlers is exceptionally rare with only two case reports describing this particular electrocardiographic pattern 2,4 …”

Fascicular and Nonfascicular Left Ventricular Tachycardias in the Young: An International Multicenter Study

“…For this study, we attempted to define a patient population, which was a pure “left posterior fascicular tachycardia” group. This tachycardia has been referred to as fascicular tachycardia, posterior fascicular tachycardia, verapamil sensitive VT, or Belhassen's tachycardia . This VT has been shown to have characteristics of a reentrant arrhythmia, originating from the Purkinje network around the left posterior septum.…”

Verapamil-Sensitive Idiopathic Left Ventricular Tachycardia in a 6-Month-Old

“…4 The postulated arrhythmia mechanism is either reentry or triggered automaticity based on clinical characteristics of individual patients. 1,2 Ventricular tachycardia is labeled as "idiopathic" when there is no structural heart disease or predisposing physiologic state. The reentry circuit seems to involve either fascicular tissue or false tendons within the ventricular cavity.…”