Authors Sung and Kim contributed equally to this work.
Diagnosis and Ablation of Multiform Fascicular Tachycardia
Version of Record online: 30 OCT 2012
© 2012 Wiley Periodicals, Inc.
Journal of Cardiovascular Electrophysiology
Volume 24, Issue 3, pages 297–304, March 2013
How to Cite
SUNG, R. K., KIM, A. M., TSENG, Z. H., HAN, F., INADA, K., TEDROW, U. B., VISWANATHAN, M. N., BADHWAR, N., VAROSY, P. D., TANEL, R., OLGIN, J. E., STEPHENSON, W. G. and SCHEINMAN, M. (2013), Diagnosis and Ablation of Multiform Fascicular Tachycardia. Journal of Cardiovascular Electrophysiology, 24: 297–304. doi: 10.1111/jce.12020
Funding for this study was in part provided in part by a Research Career Development Award (RCD 04–115-2 to Dr. Varosy) from the Veterans Administration Office of Health Services Research and Development.
Dr. Kim was a UCSF faculty member during the period of clinical care discussed in this work, and is currently appointed at the West Roxbury VA Hospital. He is a full-time employee of the Novartis Institutes for Biomedical Research, Inc., and declares no conflicts of interest with this work. Dr. Tedrow reports research grants from Biosense Webster and Boston Scientific, and speaking honoraria from Boston Scientific, Medtronic, and St. Jude Medical. Dr. Olgin reports research grant support from Intermune, Inc., Zoll, Medtronic, GE, and Gilead. Dr. Scheinman reports honoraria for teaching activities from St. Jude Medical, Boston Scientific, Medtronic, Inc., and Biotronik. Other authors: No disclosures.
- Issue online: 4 MAR 2013
- Version of Record online: 30 OCT 2012
- Accepted manuscript online: 20 SEP 2012 01:20PM EST
- Manuscript received 9 June 2012; Revised manuscript received 11 September 2012; Accepted for publication 14 September 2012.
- catheter ablation;
- bundle branch reentrant ventricular tachycardia;
- fascicular tachycardia;
- ventricular tachycardia
Ablation Multiform Fascicular Tachycardia. Introduction: Fascicular tachycardia (FT) is an uncommon cause of monomorphic sustained ventricular tachycardia (VT). We describe 6 cases of FT with multiform QRS morphologies.
Methods and Results : Six of 823 consecutive VT cases were retrospectively analyzed and found attributable to FT with multiform QRS patterns, with 3 cases exhibiting narrow QRS VT as well. All underwent electrophysiology study including fascicular potential mapping, entrainment pacing, and electroanatomic mapping. The first 3 cases describe similar multiform VT patterns with successful ablation in the upper mid septum. Initially, a right bundle branch block (RBBB) VT with superior axis was induced. Radiofrequency catheter ablation (RFCA) targeting the left posterior fascicle (LPF) resulted in a second VT with RBBB inferior axis. RFCA in the upper septum just apical to the LBB potential abolished VT in all cases. Cases 4 and 5 showed RBBB VT with alternating fascicular block compatible with upper septal dependent VT, resulting in bundle branch reentrant VT (BBRT) after ablation of LPF and left anterior fascicle (LAF). Finally, Cases 5 and 6 demonstrated spontaneous shift in QRS morphology during VT, implicating participation of a third fascicle. In Case 6, successful ablation was achieved over the proximal LAF, likely representing insertion of the auxiliary fascicle near the proximal LAF.
Conclusions : Multiform FTs show a reentrant mechanism using multiple fascicular branches. We hypothesize that retrograde conduction over the septal fascicle produces alternate fascicular patterns as well as narrow VT forms. Ablation of the respective fascicle was successful in abolishing FT but does not preclude development of BBRT unless septal fascicle is targeted and ablated. (J Cardiovasc Electrophysiol, Vol. 24, pp. 297-304, March 2013)