Key result
Catheter ablation targeting a site with a late retrograde-Purkinje potential successfully treated idiopathic left posterior fascicular ventricular tachycardia, with the patient remaining arrhythmia-free at 21 months.
Why the study?
Verapamil efficacy in fascicular ventricular tachycardia is variable and can be poorly tolerated due to side effects, warranting catheter ablation strategies.
Does catheter ablation at a site with late retrograde-Purkinje potentials prevent recurrence of idiopathic left posterior fascicular ventricular tachycardia?
Case Report (n=1)
No
Does catheter ablation at a site with late retrograde-Purkinje potentials prevent recurrence of idiopathic left posterior fascicular ventricular tachycardia?
Ablation at any site with retrograde-Purkinje potentials, including late potentials, along the left ventricular posterior fascicular network may be sufficient to disrupt the ILPFVT circuit.
May support targeting late retrograde-Purkinje potentials for ILPFVT; hypothesis-generating from single case and requires prospective validation.
Slow entry of calcium in partially depolarized Purkinje fibres is thought to mediate the genesis of fascicular ventricular tachycardia (VT). Verapamil reverses this influx and is effective at terminating VT. However, the efficacy of verapamil is variable and it may not be well tolerated due to side-effects, as seen in the case presented here. Idiopathic left posterior fascicular VT (ILPFVT) can be treated by localised catheter ablation in the left ventricular septum with a high success rate. Ablating at sites with the earliest retrograde-Purkinje potential (retro-PP) can be used for guiding successful ablation. In the case presented here, ablation at a site with a late retro-PP resulted in a successful ablation. This indicates that ablation at any site with retro-PP along the left ventricular posterior fascicular network may be sufficient in disrupting the ILPFVT circuit.
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Mahmood et al. (2020) conducted a case report in Idiopathic left posterior fascicular ventricular tachycardia (ILPFVT) (n=1). Catheter ablation targeting late retrograde-Purkinje potentials was evaluated on Arrhythmia-free survival. Catheter ablation targeting a site with a late retrograde-Purkinje potential successfully treated idiopathic left posterior fascicular ventricular tachycardia, with the patient remaining arrhythmia-free at 21 months.
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