Fascicular ventricular tachycardia

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BACKGROUND: The anatomical substrate for left posterior fascicular ventricular tachycardia (LPF-VT) is still unclear. OBJECTIVES: The purpose of this study is to describe the endocavitary substrate of the re-entrant loop of LPF-VT. METHODS: Twenty-six consecutive patients with LPF-VT underwent an electrophysiology study and radiofrequency ablation. RESULTS: Intracardiac echocardiography imaging observed a 100% prevalence of false tendons (FTs) at the left posterior septal region in all patients, and 3 different types of FTs could be classified according to their location...

Cardiomyopathies are a heterogeneous group of pathologies characterized by structural and functional alterations of the heart. Recent technological advances in cardiovascular imaging offer an opportunity for deep phenotypic and etiological definition. Electrocardiogram (ECG) is the first-line diagnostic tool in the evaluation of both asymptomatic and symptomatic individuals. Some electrocardiographic signs are pathognomonic or fall within validated diagnostic criteria of individual cardiomyopathy such as the inverted T waves in right precordial leads (V1-V3) or beyond in individuals with complete pubertal development in the absence of complete right bundle branch block for the diagnosis of arrhythmogenic cardiomyopathy of the right ventricle (ARVC) or the presence of low voltages typically seen in more than 60% of patients with amyloidosis...

During tachycardia, His-bundle potentials preceded Purkinje potentials. When the radiofrequency application was performed at a site where Purkinje potentials could be recorded slightly more peripherally than His-bundle potentials, tachycardia temporarily stopped, but was quickly followed by tachycardia with left-axis deviated because of the complication of the left anterior fascicular block.

Ventricular tachycardias involving the fascicular system are amongst the most challenging and intriguing arrhythmias for cardiac electrophysiologists. Although some of the more common forms have been recognized clinically for decades, other variants continue to be characterized. Moreover, considerable uncertainty persists to date with regards to the mechanisms underpinning these arrhythmias. In this state-of-the-art review, we discuss the seminal historical and contemporary observations that have collectively advanced our understanding of fascicular ventricular tachycardias...

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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...

AIMS: The aim of this study was to investigate the electrophysiological characteristics and long-term outcome of patients undergoing substrate-based ablation of left posterior fascicular ventricular tachycardia (LPF-VT) guided by targeting of fragmented antegrade Purkinje potentials (FAPs) during sinus rhythm. METHODS AND RESULTS: This study retrospectively analysed 50 consecutive patients referred for ablation. Substrate mapping during sinus rhythm was performed to identify the FAP that was targeted by ablation...

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A 29-year-old man with moderate coronavirus disease 2019 (COVID-19) pneumonia presented with a one-day history of palpitations. On examination, he was febrile and tachycardic (pulse rate of 182 beats per minute), with a blood pressure of 120/80 mmHg and oxygen saturation of 96%. Electrocardiography revealed sustained monomorphic wide-complex tachycardia. Carotid sinus massage and adenosine administration were ineffective. Although amiodarone administration slowed the heart rate and relieved his symptoms, sinus rhythm was not restored...

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...

The Purkinje system has been found to mediate several monomorphic ventricular tachycardias (VTs). These include fascicular VTs and bundle branch reentrant (BBR) VTs. Previous studies have revealed that VTs involving the His-Purkinje system are composed of multiple discrete subtypes that are best differentiated by their mechanism, drug effect, VT morphology, and successful ablation site. Recognition of the heterogeneity of these VTs and their unique characteristics should facilitate the appropriate diagnosis and therapy and help guide catheter ablation therapy...

Narrow complex tachycardia (NCT) is often due to supraventricular tachycardia (SVT). SVT with aberrancy, preexcitation, paced rhythm, rate-dependent bundle branch block, preexisting conduction defects or SVT due to drugs, and electrolyte abnormality can also be wide complex. Wide-complex tachycardia (WCT) is often ventricular tachycardia (VT), but fascicular VT (fVT) can present as NCT. Thus, WCT can be either VT or SVT. This has been a perplexing problem for the emergency physician for ages. Here, in this case series, we describe the novel use of point-of-care ultrasound to differentiate SVT from VT...

BACKGROUND: Idiopathic ventricular tachycardia (VT) in children with structurally normal hearts is generally unrelated to the risk of sudden arrhythmic death. Still, it may be associated with deterioration in the quality of life. VT involving the fascicular conduction system is the most typical form of idiopathic left VT. In this retrospective study, we describe the experience of the clinical presentation, catheter ablation, and long-term follow-up of left fascicular VT in children. METHODS: An electrophysiological study was performed on consecutive children at a single tertiary center...

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Background Chagas disease is a neglected tropical disease that is still considered a global health emergency. In the Amazon region, most of the reports are of acute cases that are associated with oral transmission. This study aimed to evaluate myocardial injury in patients with acute Chagas disease before and after treatment. Methods and Results We evaluated 23 patients with acute Chagas disease in 3 different stages of progression. Group 1 had 12 patients evaluated during the acute phase, at the time of diagnosis, and 1 year after treatment, and Group 2 had 11 patients in the late postacute phase who were evaluated 5...

Context: Idiopathic ventricular arrhythmias (IVAs) are a spectrum of ventricular arrhythmia (VA) without structural heart disease (SHD), that includes premature ventricular contractions (PVCs) and ventricular tachycardia (VT). The clinical characteristics of patients with PVCs or VT remain unclear, including distribution of the origin of arrhythmias, age and gender differences, comorbidities, laboratory tests, and electrocardiographic parameters. Objective: The study intended to compare the clinical characteristics of the right ventricular outflow tract (RVOT)- and left ventricular outflow tract (LVOT)-VT of a large group of consecutive patients, to investigate the distribution of the origin of the arrhythmias, age and gender differences, comorbidities, laboratory-examination results, and echocardiographic parameters...

A 13-year male patient with a history of tachycardia attacks was diagnosed to have left posterior fascicular ventricular tachycardia (VT) according to the electrocardiogram (ECG) obtained at the emergency service. This diagnosis was confirmed with advanced electrophysiological studies and the case was diagnosed by genetic evaluation, which was performed to reveal the underlying cause, to have Brugada type 2 syndrome that might be associated with sudden cardiac death. Underlying causes should be evaluated, although idiopathic VTs generally have a good prognosis...

Ventricular tachycardia in pediatric emergency department patients is a high-risk, low-frequency event well suited for education through simulation. This technical report describes a simulation-based curriculum for Pediatric Emergency Medicine fellows and senior residents involving the evaluation and management of a 10-year-old female presenting with palpitations who is ultimately diagnosed with Belhassen tachycardia. The curriculum highlights the features that differentiate Belhassen tachycardia (idiopathic left posterior fascicular ventricular tachycardia) from supraventricular or other tachycardias, building upon foundational pediatric resuscitation skills and Pediatric Advanced Life Support (PALS) algorithms for advanced learners...