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Idiopathic Accelerated Idioventricular Rhythm or Ventricular Tachycardia Originating from the Right Bundle Branch: An Unusual Type of Ventricular Arrhythmia.
MedLine Citation:
PMID:  25378469     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: -Accelerated idioventricular rhythm (AIVR) or ventricular tachycardia (VT) originating from the right bundle branch (RBB) is rare and published clinical data regarding such arrhythmia is scarce. In this study, we will describe the clinical manifestations, diagnosis and management of a cohort of patients with this novel arrhythmia.
METHODS AND RESULTS: -Eight patients (5 males; median age 25 years) with RBB-AIVR/VT were consecutively enrolled in the study. Pharmacologic testing, exercise treadmill testing, electrophysiological study and catheter ablation were performed in the study patients and ECG features were characterized. All RBB-AIVR/VTs were of typical LBBB morphology with atrio-ventricular dissociation. The arrhythmias demonstrated chronotropic variability, were often isorhythmic with sinus rhythm, and were accelerated by physical exercise, stress, and intravenous isoprenaline infusion. The rate of RBB-AIVR/VT varied from 45 to 200 bpm. Two patients experienced syncope and three had impaired LV function. Metoprolol was proven to be the most effective drug to decelerate the arrhythmia rate and relieve symptoms. Electrophysiology study was performed in 5 patients and the earliest activation with a sharp RBB potential was localized in the mid or distal RBB area. Catheter ablation terminated the arrhythmia with subsequent RBBB morphology during sinus rhythm. During follow-up, patients' symptoms were controlled with normalization of LV function either on metoprolol or by catheter ablation.
CONCLUSIONS: -RBB-AIVR/VT is an unusual type of ventricular arrhythmia. It can result in significant symptoms and depressed ventricular function and can be successfully treated with catheter ablation.
Authors:
Minglong Chen; Kai Gu; Bing Yang; Hongwu Chen; Weizhu Ju; Fengxiang Zhang; Gang Yang; Mingfang Li; Xinzheng Lu; Kejiang Cao; Feifan Ouyang
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-11-6
Journal Detail:
Title:  Circulation. Arrhythmia and electrophysiology     Volume:  -     ISSN:  1941-3084     ISO Abbreviation:  Circ Arrhythm Electrophysiol     Publication Date:  2014 Nov 
Date Detail:
Created Date:  2014-11-7     Completed Date:  -     Revised Date:  2014-11-8    
Medline Journal Info:
Nlm Unique ID:  101474365     Medline TA:  Circ Arrhythm Electrophysiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
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