Bundle Branch Reentrant Ventricular Tachycardia:

Blanck, Zalmen; Dhala, Anwer; Deshpande, Sanjay; Sra, Jasbír; Jazayeri, Mohammad; Akhtar, Masood

doi:10.1111/j.1540-8167.1993.tb01228.x

Cited by 250 publications

(122 citation statements)

References 11 publications

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“…RF catheter ablation of the bundle branches is curative of the arrhythmia but not of the underlying structural abnormality (301). Because of the severity of underlying heart disease and the high prevalence of conduction abnormalities, adjunct device therapy should be strongly considered in these patients (301).…”

Section: Bundle-branch Reentrant Vtmentioning

confidence: 99%

ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death

Zipes¹,

Camm²,

Borggrefe³

et al. 2006

Circulation

1,204

671

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Section: Bundle-branch Reentrant Vtmentioning

confidence: 99%

ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death

Zipes¹,

Camm²,

Borggrefe³

et al. 2006

Circulation

1,204

671

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“…Clockwise BBRVT with underlying LBBB is rare, but not impossible. 3,4 In the present case, the left bundle is more diseased than the right bundle, and thus LBBB was observed during SR. However, conduction delay, rather than complete block, allowed conduction down the left bundle during clockwise BBRVT as well as during SR, as evident by r>1 mm in V1 in SR suggesting preserved left to right septal activation, and thus preserved left bundle conduction.…”

Section: Circ Arrhythm Electrophysiolmentioning

confidence: 69%

“…The tachycardia induction during programmed extrastimulation from RV was dependent on critical delays in both limbs of the His-Purkinje system. 4 The earliest surface QRS onset during tachycardia was in precordial lead V3. Relative to lead V3, onset occurred 28 ms later in V1, and 44 ms later in distal His.…”

Section: Circ Arrhythm Electrophysiolmentioning

confidence: 99%

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Paradoxical Ventricular Activation Sequence and ParaHisian Entrainment Response

Nayyar

Young

Sanders

et al. 2013

Circ: Arrhythmia and Electrophysiology

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. Bundle-branch reentry and the postpacing interval after entrainment by right ventricular apex stimulation: a new approach to elucidate the mechanism of wide-QRS-complex tachycardia with atrioventricular dissociation. Circulation. 2001;103:1102-1108 KEY WORDS: bundle-branch re-entry ◼ entrainment ◼ parahisian pacing ◼ ventricular tachycardia Figure 7. Schematic for activation in clockwise bundle-branch re-entrant ventricular tachycardia. The anatomy of bundle-branches is drawn, as previously described by Massing and James. 7 The left bundle-branch divides in the basal septum at a variable length below aortic valve to anterior and posterior fascicles (LAF, LPF). The additional midseptal fiber groups from left bundle distribute into the septum in unpredictable number, configurations, and locations (small yellow asterisks within the septum). The LAF distributes in basal and anterior left ventricle, whereas LPF distributes more apically into posterior left ventricle (large black asterisks). The right bundle-branch (RBB) has a longer septal course toward apex before it exits at the base of anterior papillary muscle, where it divides into 2 divisions, entering moderator band and right ventricular (RV) endocardium (large asterisks). The course of activation during tachycardia in right and left bundle-branches is shown by the dotted line, and bold arrows represent points of entry and exit to and from the respective bundles. The crescentric shaded area represents the portion of the muscular septum participating in the circuit. There is no septal scarring and the numbers represent orthodromically activated time zones of septal myocardium after exit of the tachycardia impulse from the midseptal fibers. Catheters are shown at His and RV apex (RVA) locations (black squares). When the exit is in the middle septum, ventricular activation at basal septum near His can precede or is simultaneous to activation at the RV apex (A). When the exit is in the high septum, ventricular activation at basal septum near His will precede activation at the RV apex (B). When the exit is in the low septum, ventricular activation at RV apex will precede activation at the basal septum near His (C). EDITOR'S PERSPECTIVENayyar et al describe a patient with atypical bundle-branch re-entry that provide the student of electrophysiology an opportunity to appreciate the limitations of our knowledge regarding interventricular connections for conduction and the need for deduction when a complete circuit cannot be mapped. The case shows us that the RV apex is not the site of initial RV actionation when transseptal conduction occurs in this arrhythmia. TRANSVENTRICulAR SEPTAl CONDuCTION IS THE RIgHT VENTRICulAR APEx ON PACINg IN THE PARAHISIAN REgIONThe ParaHisian RegionThe penetrating bundle of His almost invariably is located on the membranous portion of the interventricular septum. This site is at the junction of the commissure between the right and noncoronary cusps of the aortic valve, and the septal and anterior leaflets of the tricuspid valve. A sle...

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“…Traditionally, we ablate the RBB because it's superficial and it was thought that the insulated, deeper-located left bundle branch could not be readily ablated. 6,7 Chen et al 3 used a standard, 4-mmtip, nonirrigated catheter with a mean of 2.5 radiofrequency lesions to readily ablate the left bundle branch. This approach is attractive as we can leave what remains of relatively normal atrioventricular conduction through the RBB.…”

Section: Are We Now Better At Ablating the Left Bundle?mentioning

confidence: 99%