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Demonstration of Posterior Fascicle to Myocardial Conduction Block during Ablation of Idiopathic Left Ventricular Tachycardia: An Electrophysiological Predictor of Long Term Success.
MedLine Citation:
PMID:  23313803     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Idiopathic left ventricular tachycardia (ILVT) is a common form of VT in structurally normal heart. Different methods have been proposed for radiofrequency ablation (RFA) of ILVT that have good short term results but recurrence is higher. Termination of tachycardia during RFA and/or non-induciblity have been the procedural endpoints. We describe electrophysiological markers that add to long term freedom from recurrences. METHODS: Fifteen patients with ILVT underwent RFA guided by 3D electro-anatomical mapping. After creating a 3D geometry of the left ventricle (LV), the conduction system of the LV was mapped by tracing from His recording from the left ventricular outflow tract and distally till the fascicles and peri-fascicular myocardium. VT was induced using programmed electrical stimulation. Ablation was done targeting the distal posterior fascicle (DPF) and extended linearly to the surrounding myocardium, till conduction block was achieved between the fascicle-Purkinje network and the LV myocardium. RESULTS: All patients (13 men; age 32±9 years) had inducible VTs. The mean tachycardia cycle length was 320 ± 28 ms. RF energy was given to the DPF and the myocardium with an aim to achieve a myocardial -fascicular conduction block in addition to termination of VT and non-inducibility. Ablation was successful in all. No recurrence of tachycardia was seen in any patient on follow-up (20.8 ± 8.5 months). CONCLUSION: Distal posterior fascicle and Purkinje-myocardial junction is an effective target site for ILVT ablation. Demonstration of myocardial to fascicle conduction block serves as an important electrophysiological marker of successful ablation and improved long term success.
Authors:
Vikas Kataria; Amitabh Yaduvanshi; Manoj Kumar; Mohan Nair
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-1-8
Journal Detail:
Title:  Heart rhythm : the official journal of the Heart Rhythm Society     Volume:  -     ISSN:  1556-3871     ISO Abbreviation:  Heart Rhythm     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-1-14     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2013. Published by Elsevier Inc.
Affiliation:
Institute Of Cardiac Sciences, Max Superspecialty Hospital, Patparganj, New Delhi, India.
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