Bundle branch reentry: A novel mechanism for sustained ventricular tachycardia in Chagas heart disease

Sarabanda, Álvaro Valentim Lima; Gali, Wagner Luis; Gomes, Gustavo Gir

doi:10.1016/j.hrcr.2018.03.009

Cited by 7 publications

(6 citation statements)

References 11 publications

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“…A myocardial isthmus of surviving tissue between the inferolateral LV scar and the mitral valve annulus can be involved in a macroreentrant submitral circuit, as has been described for postinfarction VTs ( S9.13.3.5 ). BBR can occur but is unusual ( S9.13.3.6 ).…”

Section: Mapping and Ablationmentioning

confidence: 99%

2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias

et al. 2020

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Representative of the European Heart Rhythm Association (EHRA) †Representative of the American College of Cardiology (ACC) ‡Representative of the Sociedade Brasileira de Arritmias Cardíacas (SOBRAC) xRepresentative of the American Heart Association (AHA) {Representative of the Latin American Heart Rhythm Society (LAHRS) #Representative of the Asia Pacific Heart Rhythm Society (APHRS) **Representative of the Japanese Heart Rhythm Society (JHRS) † †Representative of the Pediatric and Congenital Electrophysiology Society (PACES)

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Section: Mapping and Ablationmentioning

confidence: 99%

2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias

et al. 2020

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“…The arrhythmia is most seen in patients with structural heart disease and concurrent significant deterioration of impulse propagation in the conduction system of the heart, such as patients with ischemic or dilated cardiomyopathy, arrhythmic right ventricular dysplasia or left ventricular non-compaction [8][9][10]. In contrast, neither acute bacterial endocarditis nor fulminant myocarditis appear to be associated with reentry-mediated VT, although case reports have been published of BBRVT in patients with Chagas disease [11].…”

Section: Discussionmentioning

confidence: 99%

Recurring episodes of bundle branch reentry ventricular tachycardia due to aortitis preceded by SARS-CoV-2 infection: a case report

Melchior

Schoos

Gang

et al. 2023

BMC Cardiovasc Disord

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Background SARS-CoV-2 may trigger both vasculitis and arrhythmias as part of a multisystem inflammatory syndrome described in children as well as in adults following COVID-19 infection with only minor respiratory symptoms. The syndrome denotes a severe dysfunction of one or more extra-pulmonary organ systems, with symptom onset approximately 2–5 weeks after the COVID-19 infection. In the present case, a seemingly intractable ventricular tachycardia preceded by SARS-CoV2 infection was only managed following the diagnosis and management of aortitis. Case presentation A 69-year-old woman was hospitalized due to syncope, following a mild COVID-19 infection. She presented with paroxysmal atrial fibrillation and intermittent ventricular tachycardia interpreted as a septum-triggered bundle branch reentry ventricular tachycardia, unaffected by amiodaron, lidocaine and adenosine. A CT-scan revealed inflammation of the aortic arch, extending into the aortic root. In the following days, the tachycardia progressed to ventricular storm with intermittent third-degree AV block. A temporary pacemaker was implanted, and radiofrequency ablation was performed to both sides of the ventricular septum after which the ventricular tachycardia was non-inducible. Following supplemental prednisolone treatment, cardiac symptoms and arrythmia subsided, but recurred after tapering. Long-term prednisolone treatment was therefore initiated with no relapse in the following 14 months. Conclusion We present a rare case of aortitis complicated with life-threatening ventricular tachycardia presided by Covid-19 infection without major respiratory symptoms. Given a known normal AV conduction prior to the COVID-19 infection, it seems likely that the ensuing aortitis in turn affected the septal myocardium, enabling the reentry tachycardia. Generally, bundle branch reentry tachycardia is best treated with radiofrequency ablation, but if it is due to aortitis with myocardial affection, long-term anti-inflammatory treatment is mandatory to prevent relapse and assure arrhythmia control. Our case highlights importance to recognize the existence of the multisystem inflammatory syndrome in adults (MIS-A) following COVID-19 infection in patients with alarming cardiovascular symptoms. The case shows that the early use of an CT-scan was crucial for both proper diagnosis and treatment option.

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“…Indeed, when the QRS complex during tachycardia is identical to the QRS complex in sinus rhythm, bundle branch reentrant ventricular tachycardia (BBRVT) is a likely diagnosis, in particular when the involvement of the Purkinje system in the antegrade axis of the tachycardia can be established as did in current tracing (Figure 2). 17 Indeed, the BBRVT was suspected based on the following findings on the intracardiac bipolar electrograms: (1) AV dissociation; (2) the presence of the HB deflections before the onset of each QRS (Figure 2); and (3) cycle length oscillations with changes in the HH interval preceding changes in the VV interval 24–34 (Figure 2). However, all of the above criteria although compatible with BBBR could be observed in also AVNRT 35 .…”

Section: Discussionmentioning

confidence: 99%

Simultaneous narrow and wide QRS complex tachycardia: Misdiagnosis or missed diagnosis?

Aslan¹,

Merovci

Tunçez

et al. 2022

Cardiovasc electrophysiol

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Bundle branch reentry: A novel mechanism for sustained ventricular tachycardia in Chagas heart disease

Cited by 7 publications

References 11 publications

2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias

2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias

Recurring episodes of bundle branch reentry ventricular tachycardia due to aortitis preceded by SARS-CoV-2 infection: a case report

Simultaneous narrow and wide QRS complex tachycardia: Misdiagnosis or missed diagnosis?

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