Ablation for idiopathic left ventricular tachycardia in a patient with double outlet right ventricle who underwent Fontan operation: a case report

Background The incidence of ventricular tachycardia (VT) in patients following Fontan operation is reported as 3.5%. Furthermore, in patients with repaired double outlet right ventricle (DORV), scar-related VT and outflow tract VT have been reported; however, Purkinje-related VT has not previously been reported. In this report, we present the case of idiopathic left VT (ILVT) in a patient with DORV who underwent Fontan operation. Case summary A 31-year-old man was diagnosed as having DORV with complete atrioventricular defect at birth. When he was 17 years old, he underwent surgical repair, including extracardiac Fontan operation and common atrioventricular valve replacement. Five years later, VT was detected. Since some medications were ineffective in suppressing VT, he was referred to our hospital for definitive treatment. Ventricular tachycardia was induced by atrial and ventricular programmed electrical stimulations. The mechanism of the VT was determined to be re-entry. The earliest activation site was located at the mid-inferior septum of the hypoplastic left ventricle, in which Purkinje potentials were observed before the local ventricular electrogram. Radiofrequency catheter ablation (RFCA) was performed at this site to eliminate VT. Discussion Most VTs originate from surgical scars in patients with congenital heart disease. Catheter ablation was feasible in scar-related VT. To the best of our knowledge, this is the first report of ILVT treated successfully with RFCA in a DORV patient who had undergone Fontan operation.

Idiopathic Left Ventricular Tachycardia Originating in the Left Posterior Fascicle

Ventricular tachycardias originating from the Purkinje system are the most common type of idiopathic left ventricular tachycardia. The majority if not all of the reentrant circuit involved in this type of tachycardia is formed by the Purkinje fibres of the left bundle branch, particularly the left posterior fascicle. In general, slowly conducting Purkinje fibres (P1) form the antegrade limb, and normally conducting Purkinje fibres (P2) form the retrograde limb of the reentrant circuit of the ventricular tachycardia originating from the left posterior fascicle. Elimination of the critical Purkinje elements in the reentrant circuit is the route to successful ablation. While the reentrant circuit identified by activation mapping provides the roadmap to ablation targets, comparing the difference in the His-ventricular interval during sinus rhythm and tachycardia also helps to identify the critical site in the reentrant circuit.

Is narrow qrs complex tachyarrythmia always from supraventricular?

Idiopathic left ventricular tachycardia (previously known as fascicular VT) is characterized by right bundle branch block (RBBB) left axis ventricular tachycardia (VT) with a relatively narrow QRS (120–140 ms) in young patients and sensitive to verapamil. Objective: To remind that not all tachyarrhythmias with relatively narrow QRS are derived from supraventricular. Cases: First case of 23 years old man with chief complain palpitation and presyncope with narrow QRS ventricular tachycardia electrocardiography (ECG). Second case of 16 years old man with chief complain palpitation with narrow QRS ventricular tachycardia ECG, both of them are getting better after administration of diltiazem and verapamil. Conclusions: Idiopathic left ventricular tachycardia is associated with presyncope, palpitation and was successfully terminated with verapamil. Medical management is variable in its outcomes and given the age of the population affected. Narrow QRS complex tachycardia not always from supraventricular, we should think about ventricular tachycardia especially ILVT if there is no structural heart disease.

New implications for the recurrence mechanism of an upper septal ventricular tachycardia: a case report

Background Verapamil-sensitive fascicular ventricular tachycardia (VT) is the most common type of idiopathic left ventricular tachycardia, and it is divided into three types. Upper septal ventricular tachycardia (US-VT) is likely in patients with prior episodes of left posterior fascicular (LPF)-VT ablation, however, little is known about the recurrence mechanism of US-VT. Case summary A 53-year-old man had an US-VT after two catheter ablation sessions for a common idiopathic LPF-VT. The US-VT was successfully treated by ablating the proximal site of the LPF without making any further branch or fascicular block. This successful ablation point corresponded completely with the earliest pre-systolic potential (P2) site of the LPF-VT during the 1st session of catheter ablation. Discussion An US-VT recurrence could occur if a critical slow conduction is not affected by the catheter ablation. This recurrence might be the result of changing the re-entrant circuit after damage to the LPF. In order to eliminate the LPF-VT and prevent an US-VT recurrence, the earliest P2 site should be investigated carefully and ablated sufficiently.

IDIOPATHIC LEFT VENTRICULAR TACHYCARDIA: A CASE REPORT

ABSTRACTAccurate diagnosis of wide QRS complex tachycardia is difficult in emergent situations. Idiopathic Left Ventricular Tachycardia (ILVT) is a ventricular tachycardia characterized by right bundle branch block (RBBB) and left axis deviation (LAD) on electrocardiogram, its accounts for 10-15% of all left ventricular tachycardias. We present case of ILVT in a young 32-year-old gentleman presenting with unstable hemodynamic and a wide-complex right bundle, left axis deviation on electrocardiogram. Electrical cardioversion was given and the ILVT was terminated. Verapamil 80 mg twice daily was given, and he planned to radiofrequency ablation. It is important for emergency physicians to recognize the electrocardiographic features of ILVT and to manage these patients appropriately.