Ventricular Tachycardia with Narrow QRS Complexes (Left Posterior Fascicular Tachycardia)

Cohen, Howard C.; Gozo, Edilberto G.; Pick, Alfred

doi:10.1161/01.cir.45.5.1035

Cited by 74 publications

(14 citation statements)

References 12 publications

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“…Clinically, most SVTs are narrow complex tachycardias (NCTs), and most VTs are broad complex tachycardias (BCTs). However, an SVT can have broad QRS complexes due to aberrant conduction or preexcitation, and a VT can have narrow QRS complexes when it originates from the bundle branches and its fascicles 5–7 …”

Section: Narrow Complex Tachycardias and Broad Complex Tachycardiasmentioning

confidence: 99%

Infraatrial Supraventricular Tachycardias: Mechanisms, Diagnosis, and Management

Lau

2008

Pacing Clinical Electrophis

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Tachycardias are traditionally classified as either ventricular tachycardia (VT) or supraventricular tachycardia (SVT). VT can be defined as a tachycardia which requires only ventricular structures for perpetuation. SVT is defined in terms of exclusion of VT and hence is any tachycardia which requires participation of at least one supraventricular structure for perpetuation. Certain SVTs require only participation of the atrioventricular node (AVN) and the His bundle (HB) but not the atrial myocardium or any of the great thoracic veins for perpetuation and hence can be described as "infraatrial." The three main mechanisms of infraatrial SVTs are: (1) intranodal atrioventricular reentrant tachycardia; (2) junctional ectopic tachycardia; and (3) nodoventricular reentrant tachycardia. The clinical significance of infraatrial SVTs is that they are compatible with any A:V ratio and even atrioventricular (AV) dissociation. Infraatrial SVTs are often suspected when a narrow complex tachycardia presents with apparent AV dissociation and a counterintuitive A:V ratio of < 1:1. However, if the same tachycardia is conducted with aberrant conduction or preexcitation, a broad complex tachycardia with an A:V ratio of < 1:1 will arise and that can be easily mistaken for VT. The possible patterns of electrical association and dissociation between different cardiac structures are examined, and how individual types of infraatrial SVT can be diagnosed and managed are reviewed.

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Section: Narrow Complex Tachycardias and Broad Complex Tachycardiasmentioning

confidence: 99%

Infraatrial Supraventricular Tachycardias: Mechanisms, Diagnosis, and Management

Lau

2008

Pacing Clinical Electrophis

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“…1) [12][13][14] It can also respond to ajmaline, sotalol or amiodarone. However, this case did not respond to any antiarrhythmic drugs, including lidocaine, verapamil, esmolol, amiodarone and adenosine.…”

Section: )11)mentioning

confidence: 99%

Radiofrequency Catheter Ablation in a Patient with Tachycardiomyopathy due to Incessant Fascicular Tachycardia

et al. 2004

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Fascicular tachycardia (FT) arising from the left posterior fascicle, one of the most common forms of idiopathic ventricular tachycardia (VT), is considered benign. Herein is presented our experience of a 25-year-old man presenting with palpitation, dyspnea and dilated cardiomyopathy due to drug-refractory FT who was successfully treated with radiofrequency catheter ablation. Echocardiography showed a dilated left ventricle (LV, 71 mm at end-diastole, 67 mm at end-systole) and decreased ejection fraction (18%). The 12-lead ECG showed a wide-QRS tachycardia (cycle length: 440 msec), with a monophasic R wave in the lead V1, left axis deviation and atrioventricular dissociation. The His-bundle electrogram revealed that the His potential preceded the ventricular activity with an abnormally short HV interval (15 msec) and dissociation of the atrial and ventricular activities. Endocardial mapping during the VT demonstrated that the Purkinje potential preceded the ventricular activity and was earliest at the upper posterior septum of LV, where the tachycardia was ablated with radiofrequency (RF) energy (30 W for 30 sec). The patient remained asymptomatic over a 6 months follow-up and the LV has returned to normal (51 mm at end-diastole, 34 mm at end-systole, ejection fraction: 62%).

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“…If, on the other hand, an adequate bundle of His electrogram is recorded during the normal beats, but no His spike is seen preceding the ectopic beats, the origin of the ectopia is well below the His in the ventricles. Occasionally, ectopic beats are found to be preceded by a bundle of His depolarization but the H-Q interval is shorter than the H-Q recorded during a normally conducted beat.51' 64,65 The QRS frequently is of the right bundle-branch block configuration suggesting that such a beat originates from a focus high in the left bundle system, either in the anterior or posterior radiations of the left Circulation, Volume XLVII, bundle branch, and that the His depolarization has been conducted retrograde from the focus. That is, the impulse is propagated orthograde to the ventricles and simultaneously retrograde to the site of recording of the His depolarization.…”

Section: His Bundle Electrography In the Evaluation Of Arrhythmiasmentioning

confidence: 99%

The His Bundle Electrogram

Haft

1973

Circulation

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The His bundle electrogram is discussed with respect to its rationale, methods for its recording and evaluation, findings with its use in the various forms of heart block and arrhythmias, its clinical value, and its limitations.Additional Indexing Words: Heart block Intraventricular conduction T HE STANDARD electrocardiogram records only electrical events of atrial and ventricular depolarization and repolarization. The origin of the impulse and information concerning conduction from the atria to the ventricles are inferred from the configuration and the relationship of the atrial to the ventricular deflections. The conduction tissue per se, however, whether within the atrium, the node, the bundle of His, or the bundle branches, does not have a representation on the electrocardiogram. Conclusions with regard to the integrity of the conduction tissue are achieved only indirectly from analysis of the depolarization of the various areas of myocardial musculature. During the P-R interval much of the depolarization of conduction tissue occurs and cannot be seen on the ECG. The A-V node is depolarized, the bundle of His is depolarized, and then, in the normal, the two bundle branches are depolarized relatively simultaneously. 1 2 With the use of the His bundle electrogram (fig.

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Ventricular Tachycardia with Narrow QRS Complexes (Left Posterior Fascicular Tachycardia)

Cited by 74 publications

References 12 publications

Infraatrial Supraventricular Tachycardias: Mechanisms, Diagnosis, and Management

Infraatrial Supraventricular Tachycardias: Mechanisms, Diagnosis, and Management

Radiofrequency Catheter Ablation in a Patient with Tachycardiomyopathy due to Incessant Fascicular Tachycardia

The His Bundle Electrogram

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