Catheter Ablation of Idiopathic Left Posterior Fascicular Ventricular Tachycardia

Ma, Wei; Lu, Fanghong; Shehata, Michael; Wang, Xunzhang; Zhang, Fan; Chen, Bingwei; Wu, Depei; He, Le; Sun, Shan; Cheng, Aijuan; Ding, Jun; Cong, Hongliang; Xu, Jing

doi:10.1161/circep.117.005240

Cited by 19 publications

(7 citation statements)

References 17 publications

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“…Fascicular VT usually presents as an incomplete RBBB morphology with a left-axis configuration and a slightly wider QRSd. 16 For example, for a QRS wave paced at the left posterior fascicle, 17 a small Q wave and tall R wave in leads I and aVL and a small R wave and deep S wave in the inferior leads are often presented. In our study, the paced QRSd was narrow and similar to that of sinus rhythm or mimicked incomplete right bundle branch aberrancy, partially complying with the criteria of VT morphology originating from the left posterior fascicle.…”

Section: Pacing Areamentioning

confidence: 99%

Permanent left bundle branch area pacing for atrioventricular block: Feasibility, safety, and acute effect

et al. 2019

Heart Rhythm

216

212

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BACKGROUND Left bundle branch area pacing (LBBAP), a new pacing approach, lacks adequate evaluation. OBJECTIVE To assess the feasibility, safety, and acute effect of permanent LBBAP in patients with atrioventricular block (AVB). METHODS A total of 33 AVB patients with indications for ventricular pacing were recruited. Electrocardiograms, pacing parameters, echocardiographic measurements, and complications associated with LBBAP were evaluated perioperatively and at 3-month follow-up. Successful LBBAP was defined as a paced QRS morphology of right bundle branch block pattern in lead V 1 and QRS duration (QRSd) less than 130 ms. RESULTS LBBAP was successfully performed in 90.9% (30/33) of patients (mean age: 55.1 6 18.5 years; 66.7% male). The mean capture threshold was similar during the procedure (0.76 6 0.26 V at 0.4 ms) and at the 3-month follow-up (0.64 6 0.20 V at 0.4 ms). The paced QRSd was 112.8 6 10.9 ms during the procedure and 116.8 6 10.4 ms at the 3-month follow-up. Baseline left or right bundle branch block was corrected (intrinsic QRSd 153.3 6 27.8 ms vs paced QRSd 122.2 6 9.9 ms) with a success rate of 68.7% (11/16). One ventricular septal lead perforation occurred soon after the procedure with characteristics of pacing failure, and lead revision was successful. Cardiac function and left ventricular synchronization by 2-dimensional echocardiographic strain imaging at the 3month follow-up slightly improved compared with that at baseline.

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Section: Pacing Areamentioning

confidence: 99%

Permanent left bundle branch area pacing for atrioventricular block: Feasibility, safety, and acute effect

et al. 2019

Heart Rhythm

216

212

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“…In the same context, if the PVC had arisen distal to the LBB, the morphology of the PVC would have caused a wider RBBB pattern and the LBB potential to ventricular interval would have been shorter during the PVC than during the normal QRS complex, because the wavefront propagation would have occurred distal to the LBB and up to the His bundle simultaneously. 2 In our case, the morphology of the PVC exhibited an incomplete RBBB pattern, and compared to the sinus QRS complex, the LBB potential to ventricular interval of the proximal bipolar electrode pair during the PVC decreased from 37 to 32 ms, but on the distal bipolar electrode pair, that interval did not change. According to the formula predicting the earliest presystolic potential of the left fascicular arrhythmia proposed by other investigator, 3 the earliest presystolic potential to ventricular interval during the sinus QRS complex of our case can be predicted as 34.5 ms.…”

Section: A S Ementioning

confidence: 44%

Bracketing of premature beats arising from the left bundle branch

Park

Kim

et al. 2019

Journal of Arrhythmia

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Fascicular premature ventricular contractions ( PVC s) can arise from anywhere in the His Purkinje system, but PVC s originating from the left bundle branch ( LBB ) are rarely reported. We report the case of PVC arising from the LBB , and also describe the electrophysiological features that might indicate the bracketing of the fascicular PVC focus.

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“…The HV interval in LPF-VT may be useful for guiding fascicle mapping base on the electro-anatomical features of the left HPS. 15 In tachycardia, the HV interval is usually described between a positive value and −30 m sec, indicating its origin in the fascicle propagating simultaneously to the His bundle and ventricle. Our study showed the mean HV interval during VT was −12.4 ± 6.9 ms, indicative of Purkinje fiber distribution in the FTs and connection between the fibers in the endocardium and the PMs or adjoining endocardium, contributing to ILVT.…”

Section: Differentiation From Vas Originating From the Pm Myocardiummentioning

confidence: 99%

Catheter ablation of idiopathic left fascicular ventricular tachycardia: Implications of false tendons for mapping and ablation

Wei

Qiu

et al. 2023

Cardiovasc electrophysiol

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Introduction The anatomical substrate for idiopathic left ventricular tachycardia (ILVT) remains speculative. Purkinje networks surrounding false tendons (FTs) might be involved in the reentrant circuit of ILVT. The objective was to evaluate the anatomical and electrophysiological features of false tendons FTs in relation to ILVT. Methods Intracardiac echocardiography (ICE) was conducted on patients with ILVT. The relationship of the FTs with ILVT was determined using electro‐anatomical mapping. Results Electrophysiological evaluation and radiofrequency ablation were conducted in 23 consecutive patients with ILVT. FTs were identified in 19/23 cases (82.6%) with P1 potentials during VT recorded at the FT in 14 of these patients (73.7%). Three FT types were identified. In type 1, the FT attached the septum to the base of the posteromedial papillary muscle (PPM) (4/19); type 2 FTs ran between the septum and the PPM apex (3/19), while in type 3, the connection occurred between the septum and apex (11/19) or between the septum and the LV free wall (1/19). The effective ILVT ablation sites were situated at the FT‐PPM (3/19) and the FT‐septum (16/19) attachment sites. Conclusions This series demonstrates the association between Purkinje fibers and FTs during catheter ablation of ILVT and verifies that left ventricular FTs are an important substrate in this type of tachycardia.

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Catheter Ablation of Idiopathic Left Posterior Fascicular Ventricular Tachycardia

Abstract: The HV interval and 12-lead ECG morphology of LPF-VT may help predict the successful site of origin and prove useful in guiding an effective ablation strategy.

Cited by 19 publications

References 17 publications

Permanent left bundle branch area pacing for atrioventricular block: Feasibility, safety, and acute effect

Permanent left bundle branch area pacing for atrioventricular block: Feasibility, safety, and acute effect

Bracketing of premature beats arising from the left bundle branch

Catheter ablation of idiopathic left fascicular ventricular tachycardia: Implications of false tendons for mapping and ablation

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