Key result
Catheter ablation targeting the earliest retrograde activation within the posterior Purkinje fiber network during sinus rhythm resulted in 92% of patients being free from recurrent VT at 8.9 years.
Why the study?
Does catheter ablation targeting the earliest retrograde activation within the posterior Purkinje fiber network during sinus rhythm prevent recurrent VT in patients with left posterior fascicular VT?
Cohort (n=24)
Does catheter ablation targeting the earliest retrograde activation within the posterior Purkinje fiber network during sinus rhythm prevent recurrent VT in patients with left posterior fascicular VT?
Catheter ablation of left posterior fascicular VT targeting the earliest retrograde activation during sinus rhythm is safe and highly effective over a median follow-up of nearly 9 years.
Answers are grounded in this paper and cite their sources.
Offers a potential durable option for left posterior fascicular VT; extends observational data but leaves randomized confirmation needed.
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.
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Wißner et al. (2012) conducted a cohort in Left posterior fascicular ventricular tachycardia (n=24). Catheter ablation targeting the earliest retrograde activation within the posterior Purkinje fiber network was evaluated on Freedom from recurrent ventricular tachycardia. Catheter ablation targeting the earliest retrograde activation within the posterior Purkinje fiber network during sinus rhythm resulted in 92% of patients being free from recurrent VT at 8.9 years.
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