Document Detail

Unusual features of an idiopathic ventricular tachycardia arising from the left ventricular outflow tract.
MedLine Citation:
PMID:  15679648     Owner:  NLM     Status:  MEDLINE    
We encountered a 40-year-old man with recurrent symptomatic palpitations manifested as monomorphic ventricular tachycardia (VT) of a right bundle branch block (RBBB) pattern with an inferior frontal axis. Physical examination, chest roentgenogram, and echocardiogram were unremarkable. The VT could be provoked by treadmill exercise testing. Electrophysiologic study revealed that the VT could be reproducibly initiated with either atrial or ventricular pacing at cycle lengths between 500 and 400 ms. With overdrive ventricular pacing, the VT could be terminated. Of note was the observation that intravenous adenosine was not effective, but intravenous verapamil could interrupt the VT. The VT was pace mapped to be arising from a site at the left ventricular outlet tract (LVOT). Notably, during pace mapping, the pacing spike was immediately followed by the beginning of the paced QRS complex, and during VT, there was no time delay between the earliest local activation and the onset of QRS complex. Furthermore, there was no mid-diastolic activity or Purkinje potential that could be recorded during sinus rhythm and VT. Subsequently, the VT was successfully ablated with radiofrequency energy as guided by pace mapping. In summary, an idiopathic VT arising from the LVOT was found to be cycle lengths- and catecholamine-dependent, adenosine-insensitive but verapamil responsive. These unusual features suggest that either microreentry or triggered activity could be the underlying mechanism.
Jen-Te Hsu; Kuo-Hung Lin; Nazar Luqman; Ruey J Sung; Chi-Tai Kuo
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Publication Detail:
Type:  Case Reports; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Pacing and clinical electrophysiology : PACE     Volume:  28     ISSN:  0147-8389     ISO Abbreviation:  Pacing Clin Electrophysiol     Publication Date:  2005 Feb 
Date Detail:
Created Date:  2005-01-31     Completed Date:  2005-06-02     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  7803944     Medline TA:  Pacing Clin Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  160-3     Citation Subset:  IM    
Division of Cardiology, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taipei, Taiwan.
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MeSH Terms
Anti-Arrhythmia Agents / therapeutic use
Bundle-Branch Block / diagnosis,  physiopathology,  surgery
Cardiac Pacing, Artificial
Catheter Ablation
Diagnosis, Differential
Tachycardia, Ventricular / diagnosis,  physiopathology*,  surgery
Ventricular Dysfunction, Left / diagnosis,  physiopathology*,  surgery
Verapamil / therapeutic use
Reg. No./Substance:
0/Anti-Arrhythmia Agents; 52-53-9/Verapamil

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