| Bundle branch reentry: a mechanism of ventricular tachycardia in the absence of myocardial or valvular dysfunction. | |
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MedLine Citation:
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PMID: 8227845 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: The aim of this study was to present bundle branch reentry as the mechanism of sustained ventricular tachycardia in the absence of myocardial or valvular dysfunction. BACKGROUND: Previous reports have documented the relation between structural heart disease and bundle branch reentrant ventricular tachycardia. Myocardial or valvular dysfunction has thus far been recognized as the only anatomic substrate for the development of this tachycardia. METHODS: Three patients with a wide QRS complex tachycardia underwent noninvasive and invasive cardiac evaluation and electrophysiologic studies to identify the substrate and mechanism of tachycardia. Catheter ablation of the right bundle branch using radiofrequency current was performed in each patient. RESULTS: The patients were all men (aged 54, 34 and 72 years) who presented with presyncope, palpitation and cardiac arrest, respectively. Electrocardiography during sinus rhythm revealed nonspecific intraventricular conduction delay in all three patients. Cardiac evaluation revealed no evidence of myocardial or valvular dysfunction in any patient. The baseline HV interval was prolonged in each patient (90, 100 and 75 ms, respectively). Programmed right ventricular stimulation initiated bundle branch reentrant tachycardia with typical left (three patients) and right (one patient) bundle branch block pattern. Catheter ablation of the right bundle branch using radiofrequency current abolished bundle branch reentry in all three patients. After 26-, 13- and 8-month follow-up periods, complete right bundle branch block persisted, and all three patients remained asymptomatic without antiarrhythmic drugs. CONCLUSIONS: Sustained bundle branch reentry can be a clinical arrhythmia in patients with no identifiable myocardial or valvular dysfunction except for isolated conduction abnormalities in the His-Purkinje system. This mechanism of tachycardia should be recognized during electrophysiologic evaluation, given the seriousness of this arrhythmia and the availability of the effective treatment. |
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Authors:
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Z Blanck; M Jazayeri; A Dhala; S Deshpande; J Sra; M Akhtar |
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Publication Detail:
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Type: Case Reports; Journal Article |
Journal Detail:
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Title: Journal of the American College of Cardiology Volume: 22 ISSN: 0735-1097 ISO Abbreviation: J. Am. Coll. Cardiol. Publication Date: 1993 Nov |
Date Detail:
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Created Date: 1993-12-08 Completed Date: 1993-12-08 Revised Date: 2010-03-24 |
Medline Journal Info:
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Nlm Unique ID: 8301365 Medline TA: J Am Coll Cardiol Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 1718-22 Citation Subset: AIM; IM |
Affiliation:
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Electrophysiology Laboratory, University of Wisconsin/Milwaukee Clinical Campus, Sinai Samaritan Medical Center. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Bundle of His / physiopathology* Bundle-Branch Block / complications*, physiopathology Electrocardiography Electrophysiology Heart Valves / physiology Humans Male Middle Aged Tachycardia, Ventricular / etiology*, physiopathology Ventricular Function / physiology |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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