The characteristics of verapamil-sensitive idiopathic left ventricular tachycardia combined with a left accessory pathway and the effect of radiofrequency catheter ablation

• Published in: Europace (London, England) Vol. 14; no. 5; pp. 703 - 708
• Main Authors: Hu, Ji-qiang, Ma, Jian, Yang, Qian, Liao, Zi-li, Hou, Yu, Zhang, Shu
• Format: Journal Article
• Language: English
• Published: England 01.05.2012
• Subjects: Accessory Atrioventricular Bundle - drug therapy; Accessory Atrioventricular Bundle - physiopathology; Accessory Atrioventricular Bundle - surgery; Adolescent; Adult; Anti-Arrhythmia Agents - therapeutic use; Catheter Ablation - methods; Child; Combined Modality Therapy; Drug Residues; Electrocardiography; Humans; Male; Retrospective Studies; Tachycardia, Atrioventricular Nodal Reentry - drug therapy; Tachycardia, Atrioventricular Nodal Reentry - physiopathology; Tachycardia, Atrioventricular Nodal Reentry - surgery; Tachycardia, Ventricular - drug therapy; Tachycardia, Ventricular - physiopathology; Tachycardia, Ventricular - surgery; Treatment Outcome; Verapamil - therapeutic use; Young Adult
• ISSN: 1099-5129; 1532-2092
• DOI: 10.1093/europace/eur330

Verapamil-sensitive idiopathic left ventricular tachycardia (ILVT) combined with a left accessory pathway (AP) is a relatively rare condition. This study examines the characteristics of patients with this condition and the effect of radiofrequency catheter ablation (RFCA). Catheter ablation was performed on 140 ILVT patients at a single centre from January 2004 to December 2009. A concealed left AP was found in seven patients (5%), all of whom were male, with an average age of 21 ± 9 years. Sustained ILVT and orthodromic atrioventricular reentrant tachycardia (AVRT) were induced in all seven patients. Retrograde activation through a bystander AP occurred concomitantly with ILVT, with an average tachycardia length of 346 ± 29 ms (range 310-400 ms). The location of the APs in four patients was left posterior, two of which showed a slow and decremental property, while in three it was left lateral. Ablation via a retrograde transaortic approach was performed in the seven patients. The left AP was ablated first in six patients, but ILVT was no longer induced in one and became non-sustained in another. In the seventh patient, ILVT was ablated first and this proved successful. Among patients with IVLT, 5% had a concomitant left AP, most of who were young men. The location of the left AP was mainly posterior and lateral, with 30% showing a slow and decremental property. Idiopathic left ventricular tachycardia and AP should be ablated simultaneously.