Electroanatomic substrate of idiopathic left ventricular tachycardia: Unidirectional block and macroreentry within the Purkinje network

• Published in: Circulation (New York, N.Y.) Vol. 105; no. 4; pp. 462 - 469
• Main Authors: FEIFAN OUYANG, CAPPATO, Riccardo, HOFFMANN-RIEM, Martin, KUCK, Karl-Heinz, ERNST, Sabine, GOYA, Masahiko, VOLKMER, Marius, HEBE, Joachim, ANTZ, Matthias, VOGTMANN, Thomas, SCHAUMANN, Anselm, FOTUHI, Parwis
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 29.01.2002
• Subjects: Adolescent; Adult; Biological and medical sciences; Body Surface Potential Mapping - methods; Cardiac dysrhythmias; Cardiology. Vascular system; Catheter Ablation; Child; Electric Stimulation; Endocardium; Follow-Up Studies; Heart; Heart Block - diagnosis; Heart Block - physiopathology; Heart Block - therapy; Heart Conduction System; Humans; Imaging, Three-Dimensional - methods; Male; Medical sciences; Purkinje Fibers - physiopathology; Sinoatrial Node - physiopathology; Tachycardia, Ventricular - diagnosis; Tachycardia, Ventricular - etiology; Tachycardia, Ventricular - physiopathology; Tachycardia, Ventricular - therapy; Ventricular Dysfunction, Left - diagnosis; Ventricular Dysfunction, Left - physiopathology; Ventricular Dysfunction, Left - therapy; Human; Arrhythmia; Reentry; Idiopathic; Instrumentation therapy; Electrophysiology; Clinical form; Cardiovascular disease; Radiofrequency; Ablation; Excitability disorder; Left ventricle; Treatment; Heart mapping; Heart disease; Accessory bundle; Paroxysmal ventricular tachycardia
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/hc0402.102663

An abnormal potential (retroPP) from the left posterior Purkinje network has been demonstrated during sinus rhythm (SR) in some patients with idiopathic left ventricular tachycardia (ILVT). We hypothesized that this potential can specifically be identified and be a critical substrate for ILVT. In 9 patients with ILVT and 6 control patients who underwent mapping of the left ventricle during SR using 3-dimensional electroanatomic mapping, an area with retroPP was found within the posterior Purkinje fiber network only in patients with ILVT. The earliest and latest retroPP was 185.4+/-57.4 and 465.2+/-37.3 ms after Purkinje potential; in the other patient with ILVT, an entire left ventricle mapping demonstrated a slow conduction area and passive retrograde activation along the posterior fascicle during ILVT. ILVT was noninducible in 3 patients after SR mapping. Diastolic potentials critical for ILVT during ILVT coincided with the earliest retroPP during SR in 7 patients. Mechanical termination of ILVT occurred in 5 patients. A single radiofrequency pulse was applied at the site with mechanical translation in 5 patients and the site with diastolic potential in 2 patients, and 3 radiofrequency pulses were delivered to the site with the earliest retroPP in the other 3 patients without inducible ILVT after SR mapping. No ILVT was inducible during control stimulation, and none recurred during follow-up of 9.1+/-5.1 months. In patients with ILVT, abnormal retroPP within the posterior Purkinje fiber network is a common finding. The earliest retroPP critical for ILVT substrate can be used for guiding successful ablation.