Key result
Radiofrequency catheter ablation targeting the P1 or early P2 potential effectively eliminates idiopathic left ventricular tachycardia originating from the left posterior fascicle.
Successful ablation of idiopathic left ventricular tachycardia originating in the left posterior fascicle relies on identifying and eliminating critical Purkinje elements in the reentrant circuit.
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May guide ablation of posterior fascicular VT via Purkinje mapping; extends circuit insights but leaves prospective validation open.
Ventricular tachycardias originating from the Purkinje system are the most common type of idiopathic left ventricular tachycardia. The majority if not all of the reentrant circuit involved in this type of tachycardia is formed by the Purkinje fibres of the left bundle branch, particularly the left posterior fascicle. In general, slowly conducting Purkinje fibres (P1) form the antegrade limb, and normally conducting Purkinje fibres (P2) form the retrograde limb of the reentrant circuit of the ventricular tachycardia originating from the left posterior fascicle. Elimination of the critical Purkinje elements in the reentrant circuit is the route to successful ablation. While the reentrant circuit identified by activation mapping provides the roadmap to ablation targets, comparing the difference in the His-ventricular interval during sinus rhythm and tachycardia also helps to identify the critical site in the reentrant circuit.
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Chen et al. (2020) conducted a review in Idiopathic Left Ventricular Tachycardia. Radiofrequency catheter ablation was evaluated. Radiofrequency catheter ablation targeting the P1 or early P2 potential effectively eliminates idiopathic left ventricular tachycardia originating from the left posterior fascicle.
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