Document Detail

Idiopathic left ventricular tachycardia with a right bundle branch block morphology and left axis deviation ("Belhassen type"): results of radiofrequency ablation in 18 patients.
MedLine Citation:
PMID:  15115255     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Idiopathic left ventricular tachycardia with a right bundle branch block configuration and left axis deviation, first described by Belhassen et al., is a rare electrocardiographic-electrophysiologic entity. Radiofrequency catheter ablation has been proposed as a good therapeutic option, but the best criteria for determining the optimal site of ablation are still under debate. OBJECTIVES: To report the clinical features, electrophysiologic characteristics, results of RFA, and long-term outcome in 18 patients with "Belhassen's VT" treated in our laboratory during the last 10 years, stressing the best electrophysiologic criteria for determining the optimal site of ablation. METHODS: Eighteen consecutive patients with this specific VT underwent RFA in our laboratory during the last 10 years. RFA was acutely successful in 17 patients after one or two procedures (15 and 2 patients, respectively) using 4.1 +/- 2.2 RF pulses. The putative ablation sites were defined by good pace-mapping (3 patients), earliest recorded Purkinje spike prior to the QRS onset during VT or sinus rhythm (6 patients), earliest endocardial activation during VT (1 patient), and diastolic potential preceding the Purkinje spike during VT and/or late diastolic potential in sinus rhythm (7 patients). In the patients with a definite successful ablation, the ratio of successful to unsuccessful radiofrequency pulse delivery to the diastolic potential site was compared to that of other methods. The ratio of successful RFA at the diastolic potential site (5:8) was higher than in the other methods (8:31) and the difference was statistically significant (P = 0.05). Successful ablation sites were more basal when the diastolic potential site was chosen. CONCLUSION: The results of the present study confirm the high success rate and safety of RFA using conventional techniques in the management of "Belhassen VT," suggesting that this procedure can be used as a first-line therapy. Ablating at a site demonstrating a late diastolic potential is at least as effective as ablating at a ventricular exit site, although the use of combined electrophysiologic criteria may be the optimal approach.
Ian Topilski; Aharon Glick; Bernard Belhassen
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Israel Medical Association journal : IMAJ     Volume:  6     ISSN:  1565-1088     ISO Abbreviation:  Isr. Med. Assoc. J.     Publication Date:  2004 Apr 
Date Detail:
Created Date:  2004-04-29     Completed Date:  2004-05-20     Revised Date:  2005-03-31    
Medline Journal Info:
Nlm Unique ID:  100930740     Medline TA:  Isr Med Assoc J     Country:  Israel    
Other Details:
Languages:  eng     Pagination:  195-200     Citation Subset:  IM    
Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
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MeSH Terms
Catheter Ablation*
Electrophysiologic Techniques, Cardiac*
Heart Conduction System / surgery*
Middle Aged
Tachycardia, Ventricular / complications,  physiopathology,  surgery*
Comment In:
Isr Med Assoc J. 2004 Apr;6(4):233-4   [PMID:  15115263 ]

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