Document Detail


Creation of Partial Fascicular Block: An Approach to Ablation of Idiopathic Left Ventricular Tachycardia in the Pediatric Population.
MedLine Citation:
PMID:  25469902     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Catheter ablation of idiopathic left ventricular tachycardia in the pediatric population remains challenging. A recent multicenter study reported limited success with 14% not undergoing ablation due to inability to induce ventricular tachycardia (VT) or blood pressure instability during tachycardia. Creating complete or partial fascicular block with radiofrequency catheter ablation is a technique that may eliminate VT. This approach is performed during sinus rhythm, enabling atrioventricular conduction monitoring and maintaining stable hemodynamics. Importantly, induction of VT is not necessary for mapping or assessing efficacy of the procedure.
METHODS: A retrospective review of pediatric patients (3-17 years) with recurrent, documented idiopathic left ventricular tachycardia by electrocardiogram who received catheter ablation by creating fascicular block as a therapeutic endpoint was performed. All had ablation at the site of an identified Purkinje potential.
RESULTS: There were six patients with idiopathic left ventricular tachycardia, five originating from the posterior fascicle and one from the anterior fascicle. VT was not induced or spontaneous in four patients using programmed stimulation and isoproterenol infusion. All patients had a QRS axis shift following ablation, though none met criteria for fascicular block. At follow up (7-49 months, mean 27 months), all patients had persistence of this shift. There were no recurrences of VT and none of the patients were taking antiarrhythmic medication.
CONCLUSION: The technique of creating partial fascicular block appears to be a safe and effective approach to ablation of idiopathic left ventricular tachycardia in children.
Authors:
Steven B Fishberger; Melissa M Olen; Nancy L Rollinson; Anthony F Rossi
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-12-2
Journal Detail:
Title:  Pacing and clinical electrophysiology : PACE     Volume:  -     ISSN:  1540-8159     ISO Abbreviation:  Pacing Clin Electrophysiol     Publication Date:  2014 Dec 
Date Detail:
Created Date:  2014-12-3     Completed Date:  -     Revised Date:  2014-12-4    
Medline Journal Info:
Nlm Unique ID:  7803944     Medline TA:  Pacing Clin Electrophysiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2014 Wiley Periodicals, Inc.
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