Electroanatomic substrate of idiopathic left ventricular tachycardia - Unidirectional block and macroreentry within the Purkinje network

被引:148
作者
Ouyang, F
Cappato, R
Ernst, S
Goya, M
Volkmer, M
Hebe, J
Antz, M
Vogtmann, T
Schaumann, A
Fotuhi, P
Hoffmann-Riem, M
Kuck, KH
机构
[1] Allgemeines Krankenhaus St Georg, Zweite Med Abt, Hamburg, Germany
[2] San Donato Hosp, Dept Cardiol, Milan, Italy
关键词
catheter ablation; electrophysiology; mapping; tachycardia;
D O I
10.1161/hc0402.102663
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background-An abnormal potential (retroPP) from the left posterior Purkinje network has been demonstrated during sinus rhythm (SR) in some patients with idiopathic left ventricular tachycardia (ILVT). We hypothesized that this potential can specifically be identified and be a critical substrate for ILVT. Methods and Results-In 9 patients with ILVT and 6 control patients who underwent mapping of tire left ventricle during SR using 3-dimensional electroanatomic mapping, an area with retroPP was found within the posterior Purkinje fiber network only in patients with ILVT. The earliest and latest retroPP was 185.4+/-57.4 and 465.2+/-37.3 ms after Purkinje potential. in the other patient with ILVT, an entire left ventricle mapping demonstrated a slow conduction area and passive retrograde activation along the posterior fascicle during ILVT. ILVT was noninducible in 3 patients after SR mapping. Diastolic potentials critical for ILVT during ILVT coincided with the earliest retroPP during SR in 7 patients. Mechanical termination of ILVT occurred in 5 patients. A single radiofrequency pulse was applied at the site with mechanical translation in 5 patients and the site with diastolic potential in 2 patients, and 3 radiofrequency pulses were delivered to the site with the earliest retroPP in the other 3 patients without inducible ILVT after SR mapping. No ILVT was inducible during control stimulation. and none recurred during follow-up of 9.1+/-5.1 months. Conclusion-In patients with ILVT, abnormal retroPP within the posterior Purkinje fiber network is a common finding. The earliest retroPP critical for ILVT substrate can be used for guiding successful ablation.
引用
收藏
页码:462 / 469
页数:8
相关论文
共 17 条
[1]  
BHARATI S, 1995, CARDIAC ARRHYTHMIAS, P1
[2]  
Gepstein L, 1997, CIRCULATION, V95, P1611
[3]   IDIOPATHIC LEFT-VENTRICULAR TACHYCARDIA - NEW INSIGHTS INTO ELECTROPHYSIOLOGICAL CHARACTERISTICS AND RADIOFREQUENCY CATHETER ABLATION [J].
KOTTKAMP, H ;
CHEN, X ;
HINDRICKS, G ;
WILLEMS, S ;
HAVERKAMP, W ;
WICHTER, T ;
BREITHARDT, G ;
BORGGREFE, M .
PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY, 1995, 18 (06) :1285-1297
[4]   Linear ablation lesions for control of unmappable ventricular tachycardia in patients with ischemic and nonischemic cardiomyopathy [J].
Marchlinski, FE ;
Callans, DJ ;
Gottlieb, CD ;
Zado, E .
CIRCULATION, 2000, 101 (11) :1288-1296
[5]   ANATOMICAL CONFIGURATION OF HIS-BUNDLE AND BUNDLE BRANCHES IN HUMAN HEART [J].
MASSING, GK ;
JAMES, TN .
CIRCULATION, 1976, 53 (04) :609-621
[6]   PROPAGATION OF IMPULSES ACROSS PURKINJE FIBER-MUSCLE JUNCTIONS IN DOG HEART [J].
MENDEZ, C ;
MUELLER, WJ ;
URGUIAGA, X .
CIRCULATION RESEARCH, 1970, 26 (02) :135-&
[7]   RADIOFREQUENCY CATHETER ABLATION OF IDIOPATHIC LEFT-VENTRICULAR TACHYCARDIA GUIDED BY A PURKINJE POTENTIAL [J].
NAKAGAWA, H ;
BECKMAN, KJ ;
MCCLELLAND, JH ;
WANG, XZ ;
ARRUDA, M ;
SANTORO, I ;
HAZLITT, HA ;
ABDALLA, I ;
SINGH, A ;
GOSSINGER, H ;
SWEIDAN, R ;
HIRAO, K ;
WIDMAN, L ;
PITHA, JV ;
LAZZARA, R ;
JACKMAN, WM .
CIRCULATION, 1993, 88 (06) :2607-2617
[8]   Demonstration of diastolic and presystolic Purkinje potentials as critical potentials in a macroreentry circuit of verapamil-sensitive idiopathic left ventricular tachycardia [J].
Nogami, A ;
Naito, S ;
Tada, H ;
Taniguchi, K ;
Okamoto, Y ;
Nishimura, S ;
Yamauchi, Y ;
Aonuma, K ;
Goya, M ;
Iesaka, Y ;
Hiroe, M .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2000, 36 (03) :811-823
[9]   IDIOPATHIC SUSTAINED LEFT-VENTRICULAR TACHYCARDIA - CLINICAL AND ELECTROPHYSIOLOGIC CHARACTERISTICS [J].
OHE, T ;
SHIMOMURA, K ;
AIHARA, N ;
KAMAKURA, S ;
MATSUHISA, M ;
SATO, I ;
NAKAGAWA, H ;
SHIMIZU, A .
CIRCULATION, 1988, 77 (03) :560-568
[10]   Characteristics of slow conduction zone demonstrated during entrainment of idiopathic ventricular tachycardia of left ventricular origin [J].
Okumura, K ;
Yamabe, H ;
Tsuchiya, T ;
Tabuchi, T ;
Iwasa, A ;
Yasue, H .
AMERICAN JOURNAL OF CARDIOLOGY, 1996, 77 (05) :379-383