Pleomorphic ventricular tachycardia originating from Purkinje fiber network of left anterior fascicle

Abstract A 55-year-old woman with recurrent syncope and palpitation experienced polymorphic ventricular tachycardia (VT) and more than 3 monomorphic VTs with a right bundle branch block configuration as inferior, middle, and superior axis. During the pleomorphic VT, the diastolic potential (dp) was...

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Bibliographic Details
Published in:Journal of electrocardiology 2010-09, Vol.43 (5), p.452-458
Main Authors: Yokoshiki, Hisashi, MD, PhD, Mitsuyama, Hirofumi, MD, Watanabe, Masaya, MD, Sakurai, Masayuki, MD, PhD, Tsutsui, Hiroyuki, MD, PhD
Format: Article
Language:English
Subjects:
Action Potentials - physiology
Bundle of His - physiopathology
Cardiovascular
Catheter Ablation
Delayed potential
Diastolic potential
Electrocardiography
Exercise Test
Female
Humans
Left anterior fascicle
Middle Aged
Pleomorphic ventricular tachycardia
Polymorphic ventricular tachycardia
Purkinje fiber network
Purkinje Fibers - physiopathology
Radiofrequency ablation
Syncope
Syncope - physiopathology
Tachycardia, Ventricular - physiopathology
Tachycardia, Ventricular - surgery
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Summary:Abstract A 55-year-old woman with recurrent syncope and palpitation experienced polymorphic ventricular tachycardia (VT) and more than 3 monomorphic VTs with a right bundle branch block configuration as inferior, middle, and superior axis. During the pleomorphic VT, the diastolic potential (dp) was recorded at the anterolateral left ventricle. Changes in the QRS morphology were associated with the time between dp and onset of QRS complex (dp-V interval), and prolongation of dp-V interval terminated the VT. In addition, the delayed potentials were seen during sinus rhythm around this area. Delivery of radiofrequency current targeting the delayed potentials abolished all the VTs. Different exits from relatively large area of slow conduction in the left anterior fascicle might have produced the pleomorphic VTs.
ISSN:0022-0736
1532-8430
DOI:10.1016/j.jelectrocard.2009.12.007