| An underrecognized subepicardial reentrant ventricular tachycardia attributable to left ventricular aneurysm in patients with normal coronary arteriograms. | |
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MedLine Citation:
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PMID: 12743007 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Feifan Ouyang; Matthias Antz; Florian T Deger; Dietmar Bänsch; Anselm Schaumann; Sabine Ernst; Karl-Heinz Kuck |
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Publication Detail:
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Type: Case Reports; Journal Article Date: 2003-05-12 |
Journal Detail:
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Title: Circulation Volume: 107 ISSN: 1524-4539 ISO Abbreviation: Circulation Publication Date: 2003 Jun |
Date Detail:
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Created Date: 2003-06-03 Completed Date: 2003-06-17 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 0147763 Medline TA: Circulation Country: United States |
Other Details:
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Languages: eng Pagination: 2702-9 Citation Subset: AIM; IM |
Affiliation:
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II. Med. Abteilung, Allgemeines Krankenhaus St Georg, Lohmühlenstr. 5, 20099 Hamburg, Germany. Ouyangfeifan@aol.com |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Body Surface Potential Mapping Bundle-Branch Block / complications, diagnosis Catheter Ablation Coronary Angiography Defibrillators, Implantable Electrocardiography Electrophysiologic Techniques, Cardiac Exercise Test Follow-Up Studies Heart Aneurysm / complications, diagnosis*, physiopathology Heart Conduction System / physiopathology, surgery Heart Ventricles / physiopathology*, radiography, surgery Humans Male Middle Aged Pericardium / physiopathology* Recurrence Reoperation Tachycardia, Ventricular / diagnosis*, etiology, surgery Ventricular Dysfunction, Left / etiology |
| Comments/Corrections | |
Comment In:
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Circulation. 2003 Dec 23;108(25):E174; author reply E174
[PMID:
14691031
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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