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Fascicular ventricular tachycardia arising from the left side His and its adjacent region: a subset of upper septal idiopathic left ventricular tachycardia

AIMS: Fascicular ventricle tachycardia (FVT) arising from the proximal aspect of left His-Purkinje system (HPS) has not been specially addressed. Current study was to investigate its clinical, electrocardiographic, and electrophysiological characteristics. METHODS AND RESULTS: Eighteen patients who...

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Autores principales: Li, Meng-Meng, Wu, Xue-Ying, Jiang, Chen-Xi, Ning, Man, Sang, Cai-Hua, Li, Song-Nan, Guo, Xue-Yuan, Wang, Wei, Zhao, Xin, Tang, Ri-Bo, Zuo, Song, Kong, Xiang-Yi, Dai, Wen-Li, Yang, Yang, Li, Xu, Long, De-Yong, Dong, Jian-Zeng, Ma, Chang-Sheng
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10062332/
https://www.ncbi.nlm.nih.gov/pubmed/36514946
http://dx.doi.org/10.1093/europace/euac233
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author Li, Meng-Meng
Wu, Xue-Ying
Jiang, Chen-Xi
Ning, Man
Sang, Cai-Hua
Li, Song-Nan
Guo, Xue-Yuan
Wang, Wei
Zhao, Xin
Tang, Ri-Bo
Zuo, Song
Kong, Xiang-Yi
Dai, Wen-Li
Yang, Yang
Li, Xu
Long, De-Yong
Dong, Jian-Zeng
Ma, Chang-Sheng
author_facet Li, Meng-Meng
Wu, Xue-Ying
Jiang, Chen-Xi
Ning, Man
Sang, Cai-Hua
Li, Song-Nan
Guo, Xue-Yuan
Wang, Wei
Zhao, Xin
Tang, Ri-Bo
Zuo, Song
Kong, Xiang-Yi
Dai, Wen-Li
Yang, Yang
Li, Xu
Long, De-Yong
Dong, Jian-Zeng
Ma, Chang-Sheng
author_sort Li, Meng-Meng
collection PubMed
description AIMS: Fascicular ventricle tachycardia (FVT) arising from the proximal aspect of left His-Purkinje system (HPS) has not been specially addressed. Current study was to investigate its clinical, electrocardiographic, and electrophysiological characteristics. METHODS AND RESULTS: Eighteen patients who were identified as this rare FVT were consecutively enrolled, and their scalar electrocardiogram and electrophysiological data were collected and analysed. The ventricular tachycardia (VT) morphology was similar to sinus rhythm (SR) in eight patients, left bundle branch block type in one patient, right bundle branch block type in seven patients, and both narrow and wide QRS type in two patients. During VT, right-sided His potential preceded the QRS with His-ventricle (H-V) interval of 36.3 ± 12.4 ms, which was shorter than that during SR (−51.4 ± 8.6 ms) (P = 0.002). The earliest Purkinje potentials (PPs) were recorded within 7 ± 3 mm of left-side His and preceded the QRS by 49.1 ± 14.0 ms. Mapping along the left anterior fascicle and left posterior fascicle revealed an antegrade activation sequence in all with no P1 potentials recorded. In the two patients with two VT morphologies, the earliest PP was documented at the same site, and the activation sequence of HPS remained antegrade. Ablation at the earliest PP successfully eliminated the tachycardia, except one patient who developed complete atrial-ventricular block and two patients who abandoned ablations. After at least 12 months follow-up, 15 patients were free from any recurrences. CONCLUSIONS: Fascicular ventricle tachycardia arising from the proximal aspect of left HPS was featured by recording slightly shorter H-V interval and absence of P1 potentials. Termination of VT requires ablation at the left-sided His or its adjacent region.
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spelling pubmed-100623322023-03-31 Fascicular ventricular tachycardia arising from the left side His and its adjacent region: a subset of upper septal idiopathic left ventricular tachycardia Li, Meng-Meng Wu, Xue-Ying Jiang, Chen-Xi Ning, Man Sang, Cai-Hua Li, Song-Nan Guo, Xue-Yuan Wang, Wei Zhao, Xin Tang, Ri-Bo Zuo, Song Kong, Xiang-Yi Dai, Wen-Li Yang, Yang Li, Xu Long, De-Yong Dong, Jian-Zeng Ma, Chang-Sheng Europace Clinical Research AIMS: Fascicular ventricle tachycardia (FVT) arising from the proximal aspect of left His-Purkinje system (HPS) has not been specially addressed. Current study was to investigate its clinical, electrocardiographic, and electrophysiological characteristics. METHODS AND RESULTS: Eighteen patients who were identified as this rare FVT were consecutively enrolled, and their scalar electrocardiogram and electrophysiological data were collected and analysed. The ventricular tachycardia (VT) morphology was similar to sinus rhythm (SR) in eight patients, left bundle branch block type in one patient, right bundle branch block type in seven patients, and both narrow and wide QRS type in two patients. During VT, right-sided His potential preceded the QRS with His-ventricle (H-V) interval of 36.3 ± 12.4 ms, which was shorter than that during SR (−51.4 ± 8.6 ms) (P = 0.002). The earliest Purkinje potentials (PPs) were recorded within 7 ± 3 mm of left-side His and preceded the QRS by 49.1 ± 14.0 ms. Mapping along the left anterior fascicle and left posterior fascicle revealed an antegrade activation sequence in all with no P1 potentials recorded. In the two patients with two VT morphologies, the earliest PP was documented at the same site, and the activation sequence of HPS remained antegrade. Ablation at the earliest PP successfully eliminated the tachycardia, except one patient who developed complete atrial-ventricular block and two patients who abandoned ablations. After at least 12 months follow-up, 15 patients were free from any recurrences. CONCLUSIONS: Fascicular ventricle tachycardia arising from the proximal aspect of left HPS was featured by recording slightly shorter H-V interval and absence of P1 potentials. Termination of VT requires ablation at the left-sided His or its adjacent region. Oxford University Press 2022-12-14 /pmc/articles/PMC10062332/ /pubmed/36514946 http://dx.doi.org/10.1093/europace/euac233 Text en © The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Clinical Research
Li, Meng-Meng
Wu, Xue-Ying
Jiang, Chen-Xi
Ning, Man
Sang, Cai-Hua
Li, Song-Nan
Guo, Xue-Yuan
Wang, Wei
Zhao, Xin
Tang, Ri-Bo
Zuo, Song
Kong, Xiang-Yi
Dai, Wen-Li
Yang, Yang
Li, Xu
Long, De-Yong
Dong, Jian-Zeng
Ma, Chang-Sheng
Fascicular ventricular tachycardia arising from the left side His and its adjacent region: a subset of upper septal idiopathic left ventricular tachycardia
title Fascicular ventricular tachycardia arising from the left side His and its adjacent region: a subset of upper septal idiopathic left ventricular tachycardia
title_full Fascicular ventricular tachycardia arising from the left side His and its adjacent region: a subset of upper septal idiopathic left ventricular tachycardia
title_fullStr Fascicular ventricular tachycardia arising from the left side His and its adjacent region: a subset of upper septal idiopathic left ventricular tachycardia
title_full_unstemmed Fascicular ventricular tachycardia arising from the left side His and its adjacent region: a subset of upper septal idiopathic left ventricular tachycardia
title_short Fascicular ventricular tachycardia arising from the left side His and its adjacent region: a subset of upper septal idiopathic left ventricular tachycardia
title_sort fascicular ventricular tachycardia arising from the left side his and its adjacent region: a subset of upper septal idiopathic left ventricular tachycardia
topic Clinical Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10062332/
https://www.ncbi.nlm.nih.gov/pubmed/36514946
http://dx.doi.org/10.1093/europace/euac233
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