Idiopathic verapamil-responsive left ventricular tachycardia: clinical characteristics and long-term follow-up of 33 patients

• Published in: European heart journal 1994-09, Vol.15 (9), p.1252-1260
• Main Authors: GAITA, F., GIUSTETTO, C., LECLERCQ, J. F., HAISSAGUERRE, M., RICCARDI, R., LIBERO, L., BARALIS, G., BRUSCA, A., COUMELF, P., WARIN, J. F.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Antiarythmic agents; Biological and medical sciences; Cardiovascular system; Catheter Ablation; Electrocardiography; Electrocardiography, Ambulatory; fascicular tachycardia; Female; Follow-Up Studies; Humans; Male; Medical sciences; Middle Aged; Mitral Valve Prolapse - complications; Pharmacology. Drug treatments; Retrospective Studies; Tachycardia, Ventricular - physiopathology; Tachycardia, Ventricular - therapy; ventricular tachycardia with right bundle branch block morphology and left axis deviation; Verapamil - therapeutic use; Verapamil-sensitive ventricular tachycardia
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/oxfordjournals.eurheartj.a060661

Long-term prognosis, pharmacological prophylaxis and transcatheter ablation in a large group of patients with idiopathic verapamil-responsive left ventricular tachycardia (1VRLVT) are reported in this study. Thirty-three patients with a mean age of 27 ± 16 years at their first IVRL VT episode, were studied retrospectively. Ventricular tachycardia was of the right bundle branch block morphology in all cases, with left axis deviation in 29 and right axis deviation in five (one patient had the two morphologies). Mitral valve prolapse was present in four patients; no heart disease was found in the remaining 29. Ventricular tachycardia could be electrophysioligically induced in 90% of the patients; Holter monitoring showed only sporadic ventricular extrasystoles in 76%; late potentials were found in 33% of the cases. At the end of a follow-up of 5.7 ± 4.7 years, no patient had died. Thirty-one patients (94%) received a mean of 2.5 ± 1.2 drugs; beta-blockers were effective in 71% of the cases, verapamil in 25%, class 1 drugs in 22%, class 3 drugs in 18%. Two patients who never received prophylaxis and four in whom it was stopped, were controlled with verapamil in case of recurrence. Six patients underwent catheter ablation; two with DC shock in whom it was successful in one, and four with radio frequency energy, with a total success rate. The good prognosis of IVRLVT has been confirmed in a long-term follow-up; a new finding is the high efficacy of beta-blockers for prophylaxis. Radio frequency transcatheter ablation is an effective and safe therapy for patients with symptoms not controlled by drug treatment.