Document Detail

An underrecognized subepicardial reentrant ventricular tachycardia attributable to left ventricular aneurysm in patients with normal coronary arteriograms.
MedLine Citation:
PMID:  12743007     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: In patients with apparently normal hearts, ventricular tachycardia (VT) may only involve the subepicardial myocardium. METHODS AND RESULTS: Four patients with exercise-induced fast VT with right bundle branch block morphology were investigated. ECG showed a small q wave in leads II, III, and aVF during sinus rhythm (SR) in all 4 patients. Left ventricular angiography showed small inferolateral aneurysms in all patients. Coronary arteriograms were normal in all 4 patients. Six unstable VTs (cycle length, 200 to 305 ms) and 1 stable VT (cycle length 370 ms) were reproducibly induced in the 4 patients. During SR, endocardial mapping was normal in all 4 patients, and epicardial mapping showed fragmented and late potentials in the left inferolateral wall anatomically consistent with the left ventricle aneurysm. During tachycardia, epicardial mapping showed a macroreentrant VT with focal endocardial activation in the patient with stable VT, whereas in 2 patients with unstable VT, a diastolic potential was only recorded and coincided with the late potential in the same area. Epicardial ablation was performed in 3 patients and successfully abolished those VTs. No VT recurred in 2 patients during follow-up of 2 and 9 months. Clinical VT recurred 6 months after the ablation and was successfully ablated in a repeated epicardial ablation in 1 patient. In the remaining patient without epicardial ablation, an implantable cardiac defibrillator was implanted. There were multiple shocks during a follow-up of 31 months. CONCLUSIONS: In patients with normal coronary arteriograms and left ventricle aneurysm, exercise-induced VT with right bundle branch block morphology may have a subepicardial arrhythmogenic substrate, which may be amenable to epicardial ablation.
Feifan Ouyang; Matthias Antz; Florian T Deger; Dietmar Bänsch; Anselm Schaumann; Sabine Ernst; Karl-Heinz Kuck
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Publication Detail:
Type:  Case Reports; Journal Article     Date:  2003-05-12
Journal Detail:
Title:  Circulation     Volume:  107     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2003 Jun 
Date Detail:
Created Date:  2003-06-03     Completed Date:  2003-06-17     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2702-9     Citation Subset:  AIM; IM    
II. Med. Abteilung, Allgemeines Krankenhaus St Georg, Lohmühlenstr. 5, 20099 Hamburg, Germany.
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MeSH Terms
Body Surface Potential Mapping
Bundle-Branch Block / complications,  diagnosis
Catheter Ablation
Coronary Angiography
Defibrillators, Implantable
Electrophysiologic Techniques, Cardiac
Exercise Test
Follow-Up Studies
Heart Aneurysm / complications,  diagnosis*,  physiopathology
Heart Conduction System / physiopathology,  surgery
Heart Ventricles / physiopathology*,  radiography,  surgery
Middle Aged
Pericardium / physiopathology*
Tachycardia, Ventricular / diagnosis*,  etiology,  surgery
Ventricular Dysfunction, Left / etiology
Comment In:
Circulation. 2003 Dec 23;108(25):E174; author reply E174   [PMID:  14691031 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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