Electroanatomic Substrate of Idiopathic Left Ventricular Tachycardia
- 29 January 2002
- journal article
- case report
- Published by Ovid Technologies (Wolters Kluwer Health) in Circulation
- Vol. 105 (4), 462-469
- https://doi.org/10.1161/hc0402.102663
Abstract
Background — An abnormal potential (retroPP) from the left posterior Purkinje network has been demonstrated during sinus rhythm (SR) in some patients with idiopathic left ventricular tachycardia (ILVT). We hypothesized that this potential can specifically be identified and be a critical substrate for ILVT. Methods and Results — In 9 patients with ILVT and 6 control patients who underwent mapping of the left ventricle during SR using 3-dimensional electroanatomic mapping, an area with retroPP was found within the posterior Purkinje fiber network only in patients with ILVT. The earliest and latest retroPP was 185.4±57.4 and 465.2±37.3 ms after Purkinje potential; in the other patient with ILVT, an entire left ventricle mapping demonstrated a slow conduction area and passive retrograde activation along the posterior fascicle during ILVT. ILVT was noninducible in 3 patients after SR mapping. Diastolic potentials critical for ILVT during ILVT coincided with the earliest retroPP during SR in 7 patients. Mechanical termination of ILVT occurred in 5 patients. A single radiofrequency pulse was applied at the site with mechanical translation in 5 patients and the site with diastolic potential in 2 patients, and 3 radiofrequency pulses were delivered to the site with the earliest retroPP in the other 3 patients without inducible ILVT after SR mapping. No ILVT was inducible during control stimulation, and none recurred during follow-up of 9.1±5.1 months. Conclusion — In patients with ILVT, abnormal retroPP within the posterior Purkinje fiber network is a common finding. The earliest retroPP critical for ILVT substrate can be used for guiding successful ablation.This publication has 7 references indexed in Scilit:
- Effects of verapamil and lidocaine on two components of the re-entry circuit of verapamil-sensitive idiopathic left ventricular tachycardiaJournal of the American College of Cardiology, 2001
- Demonstration of diastolic and presystolic purkinje potentials as critical potentials in a macroreentry circuit of verapamil-sensitive idiopathic left ventricular tachycardiaJournal of the American College of Cardiology, 2000
- Successful Radiofrequency Ablation of Idiopathic Left Ventricular Tachycardia at a Site Away From the Tachycardia ExitJournal of the American College of Cardiology, 1997
- Characteristics of slow conduction zone demonstrated during entrainment of idiopathic ventricular tachycardia of left ventricular originThe American Journal of Cardiology, 1996
- Idiopathic Left Ventricular Tachycardia: New Insights, into Electrophysiological Characteristics and Radiofrequency Catheter AblationPacing and Clinical Electrophysiology, 1995
- Catheter Ablation of Idiopathic Left Ventricular TachycardiaPacing and Clinical Electrophysiology, 1995
- Entrainment of idiopathic ventricular tachycardia of left ventricular origin with evidence for reentry with an area of slow conduction and effect of verapamilThe American Journal of Cardiology, 1988