Demonstration of posterior fascicle to myocardial conduction block during ablation of idiopathic left ventricular tachycardia: An electrophysiological predictor of long-term success

被引:10
作者
Kataria, Vikas [1 ]
Yaduvanshi, Amitabh [1 ]
Kumar, Manoj [1 ]
Nair, Mohan [1 ]
机构
[1] Max Superspecialty Hosp, Inst Cardiac Sci, New Delhi 110092, India
关键词
Catheter ablation; Ventricular tachycardia; 3-Dimensional; electroanatomical mapping; Fascicular ventricular tachycardia; Idiopathic left ventricular; tachycardia; RADIOFREQUENCY CATHETER ABLATION; UNIDIRECTIONAL BLOCK; ATRIAL-FLUTTER; SINUS RHYTHM; PURKINJE; VERAPAMIL; REENTRY;
D O I
10.1016/j.hrthm.2013.01.001
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BACKGROUND Idiopathic Left ventricular tachycardia (ILVT) is a common form of ventricular tachycardia (VT) in structurally normal heart. Different methods have been proposed for radiofrequency ablation (RFA) of ILVT that have good short-term results but recurrence is higher. Termination of tachycardia during RFA and/or noninduciblity has been the procedural end point. OBJECTIVE To describe electrophysiological markers that add to Long-term freedom from recurrences. METHODS Fifteen patients with ILVT underwent RFA guided by 3-dimensional electroanatomical mapping. After creating a 3-dimensional geometry of the Left ventricle (LV), the conduction system of the LV was mapped by tracing from His recording from the Left ventricular outflow tract and distally till the fascicles and perifascicular myocardium. VT was induced by using programmed electrical stimulation. Ablation was done targeting the distal posterior fascicle and extended Linearly to the surrounding myocardium till conduction block was achieved between the fascicle-Purkinje network and the Left ventricular myocardium. RESULTS All patients (13 men; mean age 32 +/- 9 years) had inducible VTs. The mean tachycardia cycle Length was 320 +/- 28 ms. Radiofrequency energy was given to the distal posterior fascicle and the myocardium, with an aim to achieve a myocardial-fascicular conduction Mock in addition to the termination of VT and non-inducibility. Ablation was successful in all. No recurrence of tachycardia was seen in any patient on follow-up (20.8 +/- 8.5 months). CONCLUSIONS Distal posterior fascicle and Purkinje-myocardial junction is an effective target site for ILVT ablation. The demonstration of myocardial to fascicle conduction Mock serves as an important electrophysiological marker of successful ablation and improved Long-term success.
引用
收藏
页码:638 / 645
页数:8
相关论文
共 15 条
[1]  
BELHASSEN B, 1981, BRIT HEART J, V46, P679
[2]   Successful catheter ablation of idiopathic left ventricular tachycardia during sinus rhythm [J].
Lee, Kun-Tai ;
Chu, Chih-Sheng ;
Dai, Zen-Kong ;
Wu, Jiunn-Ren ;
Sheu, Sheng-Hsiung ;
Lai, Wen-Ter .
INTERNATIONAL JOURNAL OF CARDIOLOGY, 2007, 115 (02) :E74-E77
[3]   Idiopathic fascicular left ventricular tachycardia: Linear ablation lesion strategy for noninducible or nonsustained tachycardia [J].
Lin, D ;
Hsia, HH ;
Gerstenfeld, EP ;
Dixit, S ;
Callans, DJ ;
Nayak, H ;
Russo, A ;
Marchlinski, FE .
HEART RHYTHM, 2005, 2 (09) :934-939
[4]   Dual morphology of idiopathic ventricular tachycardia [J].
Lokhandwala, YY ;
Vora, AM ;
Naik, AM ;
Nabar, A ;
Kavthale, S .
JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, 1999, 10 (10) :1326-1334
[5]   Negative Participation of the Left Posterior Fascicle in the Reentry Circuit of Verapamil-Sensitive Idiopathic Left Ventricular Tachycardia [J].
Morishima, Itsuro ;
Nogami, Akihiko ;
Tsuboi, Hideyuki ;
Sone, Takahito .
JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, 2012, 23 (05) :556-559
[6]   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
[7]   Electroanatomic substrate of idiopathic left ventricular tachycardia - Unidirectional block and macroreentry within the Purkinje network [J].
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 .
CIRCULATION, 2002, 105 (04) :462-469
[8]   UNIDIRECTIONAL BLOCK BETWEEN PURKINJE AND VENTRICULAR LAYERS OF PAPILLARY-MUSCLES [J].
OVERHOLT, ED ;
JOYNER, RW ;
VEENSTRA, RD ;
RAWLING, D ;
WIEDMANN, R .
AMERICAN JOURNAL OF PHYSIOLOGY, 1984, 247 (04) :H584-H595
[9]   Radio frequency catheter ablation of atrial flutter - Further insights into the various types of isthmus block: Application to ablation during sinus rhythm [J].
Poty, H ;
Saoudi, N ;
Nair, M ;
Anselme, F ;
Letac, B .
CIRCULATION, 1996, 94 (12) :3204-3213
[10]  
POTY H, 1995, CIRCULATION, V92, P1389