Long-Term Outcome After Catheter Ablation for Left Posterior Fascicular Ventricular Tachycardia Without Development of Left Posterior Fascicular Block

Authors

  • ERIK WISSNER M.D.,

  • S YAMKUMAR DIVAKARA MENON M.D.,

  • ANDREAS METZNER M.D.,

  • BAS SCHOONDERWOERD M.D., Ph.D.,

  • DIETER NUYENS M.D.,

  • HISAKI MAKIMOTO M.D.,

  • QINGYING ZHANG M.D.,

  • SHIBU MATHEW M.D.,

  • ALEXANDER FUERNKRANZ M.D.,

  • ANDREAS RILLIG M.D.,

  • ROLAND RICHARD TILZ M.D.,

  • KARL-HEINZ KUCK M.D., Ph.D.,

  • FEIFAN OUYANG M.D.


  • No disclosures.

Erik Wissner, M.D., Department of Cardiology, Asklepios Klinik St. Georg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany. Fax: +49-40-1818-852977; Email: e.wissner@asklepios.com

Abstract

Long-Term Outcome After Substrate-Based Ablation of LPF VT During SR. Background: Catheter ablation of left posterior fascicular (LPF) ventricular tachycardia (VT) is commonly performed during tachycardia. This study reports on the long-term outcome of patients undergoing ablation of LPF VT targeting the earliest retrograde activation within the posterior Purkinje fiber network during sinus rhythm (SR).

Methods: This study retrospectively analyzed 24 consecutive patients (8 female; mean age 26 ± 11 years) referred for catheter ablation of electrocardiographically documented LPF VT. Programmed stimulation was performed to induce tachycardia, while mapping and ablation was aided by use of a 3D electroanatomical mapping system. Catheter ablation targeted the earliest potential suggestive of retrograde activation within the posterior Purkinje fiber network (retro-PP) recorded along the posterior mid-septal left ventricle during SR if LPF VT was noninducible.

Results: Overall, 21/24 (87.5%) patients underwent successful catheter ablation in SR targeting the earliest retro-PP, while 3/24 (12.5%) patients were successfully ablated during tachycardia. In none of the patients, ablation resulted in LPF block. No procedure-related complications occurred. After a median follow-up period of 8.9 (4.8–10.9) years, 22/24 (92%) patients were free from recurrent VT.

Conclusion: In patients presenting with LPF VT, ablation of the earliest retro-PP along the posterior mid-septal LV during SR results in excellent long-term outcome during a median follow-up period of almost 9 years. (J Cardiovasc Electrophysiol, Vol. 23, pp. 1179–1184, November 2012)

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