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Electroanatomical Characteristics of Idiopathic Left Ventricular Tachycardia and Optimal Ablation Target during Sinus Rhythm: Significance of Preferential Conduction through Purkinje Fibers

PURPOSE: We hypothesized that Purkinje potential and their preferential conduction to the left ventricle (LV) posteroseptum during sinus rhythm (SR) are part of reentrant circuits of idiopathic left ventricular tachycardia (ILVT) and reentry anchors to papillary muscle. MATERIALS AND METHODS: In 14...

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Autores principales: Park, Junbeom, Kim, Young-Hoon, Hwang, Chun, Pak, Hui-Nam
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Yonsei University College of Medicine 2012
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3282975/
https://www.ncbi.nlm.nih.gov/pubmed/22318814
http://dx.doi.org/10.3349/ymj.2012.53.2.279
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author Park, Junbeom
Kim, Young-Hoon
Hwang, Chun
Pak, Hui-Nam
author_facet Park, Junbeom
Kim, Young-Hoon
Hwang, Chun
Pak, Hui-Nam
author_sort Park, Junbeom
collection PubMed
description PURPOSE: We hypothesized that Purkinje potential and their preferential conduction to the left ventricle (LV) posteroseptum during sinus rhythm (SR) are part of reentrant circuits of idiopathic left ventricular tachycardia (ILVT) and reentry anchors to papillary muscle. MATERIALS AND METHODS: In 14 patients with ILVT (11 men, mean age 31.5±11.1 years), we compared Purkinje potential and preferential conduction during SR with VT by non-contact mapping (NCM). If clear Purkinje potential((SR)) was observed in the LV posteroseptum and the earliest activation site (EA) of preferential conduction at SR (EA(SR)) was well matched with that of VT (EA(VT)), EA(SR) was targeted for radiofrequency catheter ablation (RFCA). Also, the anatomical locations of successful ablation sites were evaluated by echocardiography in five additional patients. RESULTS: 1) All induced VTs exhibited clear Purkinje potential((VT)) and preferential conduction in the LV posteroseptum. The Purkinje potential((VT)) and EA(VT) was within 5.8±8.2 mm of EA(SR). However, the breakout sites of VT were separated by 30.2±12.6 mm from EA(VT) to the apical side. 2) Purkinje potential((SR)) demonstrated a reversed polarity to Purkinje potential((VT)), and the interval of Purkinje potential((SR))-QRS was longer than the interval of Purkinje potential((VT))-QRS (p<0.02) 3) RFCA targeting EA(SR) eliminated VT in all patients without recurrence within 23.3±7.5 months, and the successful ablation site was discovered at the base of papillary muscle in the five additional (100%) patients. CONCLUSION: NCM-guided localization of EA(SR) with Purkinje potential((SR)) matches well with EA(VT) with Purkinje potential((VT)) and provides an effective target for RFCA, potentially at the base of papillary muscle in patients with ILVT.
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spelling pubmed-32829752012-03-01 Electroanatomical Characteristics of Idiopathic Left Ventricular Tachycardia and Optimal Ablation Target during Sinus Rhythm: Significance of Preferential Conduction through Purkinje Fibers Park, Junbeom Kim, Young-Hoon Hwang, Chun Pak, Hui-Nam Yonsei Med J Original Article PURPOSE: We hypothesized that Purkinje potential and their preferential conduction to the left ventricle (LV) posteroseptum during sinus rhythm (SR) are part of reentrant circuits of idiopathic left ventricular tachycardia (ILVT) and reentry anchors to papillary muscle. MATERIALS AND METHODS: In 14 patients with ILVT (11 men, mean age 31.5±11.1 years), we compared Purkinje potential and preferential conduction during SR with VT by non-contact mapping (NCM). If clear Purkinje potential((SR)) was observed in the LV posteroseptum and the earliest activation site (EA) of preferential conduction at SR (EA(SR)) was well matched with that of VT (EA(VT)), EA(SR) was targeted for radiofrequency catheter ablation (RFCA). Also, the anatomical locations of successful ablation sites were evaluated by echocardiography in five additional patients. RESULTS: 1) All induced VTs exhibited clear Purkinje potential((VT)) and preferential conduction in the LV posteroseptum. The Purkinje potential((VT)) and EA(VT) was within 5.8±8.2 mm of EA(SR). However, the breakout sites of VT were separated by 30.2±12.6 mm from EA(VT) to the apical side. 2) Purkinje potential((SR)) demonstrated a reversed polarity to Purkinje potential((VT)), and the interval of Purkinje potential((SR))-QRS was longer than the interval of Purkinje potential((VT))-QRS (p<0.02) 3) RFCA targeting EA(SR) eliminated VT in all patients without recurrence within 23.3±7.5 months, and the successful ablation site was discovered at the base of papillary muscle in the five additional (100%) patients. CONCLUSION: NCM-guided localization of EA(SR) with Purkinje potential((SR)) matches well with EA(VT) with Purkinje potential((VT)) and provides an effective target for RFCA, potentially at the base of papillary muscle in patients with ILVT. Yonsei University College of Medicine 2012-03-01 2012-01-30 /pmc/articles/PMC3282975/ /pubmed/22318814 http://dx.doi.org/10.3349/ymj.2012.53.2.279 Text en © Copyright: Yonsei University College of Medicine 2012 http://creativecommons.org/licenses/by-nc/3.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Park, Junbeom
Kim, Young-Hoon
Hwang, Chun
Pak, Hui-Nam
Electroanatomical Characteristics of Idiopathic Left Ventricular Tachycardia and Optimal Ablation Target during Sinus Rhythm: Significance of Preferential Conduction through Purkinje Fibers
title Electroanatomical Characteristics of Idiopathic Left Ventricular Tachycardia and Optimal Ablation Target during Sinus Rhythm: Significance of Preferential Conduction through Purkinje Fibers
title_full Electroanatomical Characteristics of Idiopathic Left Ventricular Tachycardia and Optimal Ablation Target during Sinus Rhythm: Significance of Preferential Conduction through Purkinje Fibers
title_fullStr Electroanatomical Characteristics of Idiopathic Left Ventricular Tachycardia and Optimal Ablation Target during Sinus Rhythm: Significance of Preferential Conduction through Purkinje Fibers
title_full_unstemmed Electroanatomical Characteristics of Idiopathic Left Ventricular Tachycardia and Optimal Ablation Target during Sinus Rhythm: Significance of Preferential Conduction through Purkinje Fibers
title_short Electroanatomical Characteristics of Idiopathic Left Ventricular Tachycardia and Optimal Ablation Target during Sinus Rhythm: Significance of Preferential Conduction through Purkinje Fibers
title_sort electroanatomical characteristics of idiopathic left ventricular tachycardia and optimal ablation target during sinus rhythm: significance of preferential conduction through purkinje fibers
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3282975/
https://www.ncbi.nlm.nih.gov/pubmed/22318814
http://dx.doi.org/10.3349/ymj.2012.53.2.279
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