Key result
Spontaneous elimination of verapamil-sensitive idiopathic left ventricular tachycardia without ablation was associated with significantly larger changes in QRS duration (30 vs 6 ms, P=0.002).
Why the study?
Do changes in QRS morphology predict spontaneous elimination of verapamil-sensitive idiopathic left ventricular tachycardia?
Cohort (n=80)
Do changes in QRS morphology predict spontaneous elimination of verapamil-sensitive idiopathic left ventricular tachycardia?
Significant changes in QRS duration and axis over time may serve as markers for the spontaneous elimination of verapamil-sensitive idiopathic left ventricular tachycardia in patients managed conservatively.
QRS duration changes may mark spontaneous ILVT resolution without ablation; leaves open whether serial ECGs predict elimination in conservatively managed patients.
BACKGROUND: Verapamil-sensitive idiopathic left ventricular tachycardia (verapamil-ILVT) is thought to be due to a reentry within the LV fascicular system. Radiofrequency catheter ablation (RFCA) is effective for elimination of the VT; however, a long-term prognosis of patients with verapamil-ILVT is still unclear. METHODS AND RESULTS: Eighty consecutive verapamil-ILVT patients (62 men, 31 ± 12 years of age, LVEF: 65 ± 4%) were enrolled. Seventy-six (95%) cases of VT involved right bundle branch block and left axis deviation. We retrospectively analyzed changes in the QRS duration (ΔQRS-d) and QRS axis (ΔQRS-axis) during follow-up and compared them with recurrence of VT. During a mean follow-up period of 10 years (2-32 years), no sudden death or heart failure occurred. Fifty-one (64%) patients underwent RFCA, and 46 (90%) of them had no VT without any medication after RFCA. The ΔQRS-d (16 ± 2 vs. 8 ± 1 ms, P = 0.24) and ΔQRS-axis (20 ± 4 vs. 4 ± 3 degrees, P = 0.23) were not different in patients with no VT (VT[-]) and those with recurrence of VT (VT[+]). However, in the remaining 29 patients without RFCA, VT was spontaneously eliminated in 16 patients. The ΔQRS-d (30 ± 6 vs. 6 ± 1 ms, P = 0.002) and ΔQRS-axis (23 ± 4 vs. 5 ± 2 degrees, P = 0.001) were significantly larger in VT(-) patients compared to VT(+) patients during follow-up. CONCLUSIONS: Some verapamil-ILVT patients who show QRS morphology changes over the follow-up period may become free from VT without any invasive or pharmacological treatments, suggesting that further altered LV fascicular conduction might eliminate the reentry of verapamil-ILVT.
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Kawakami et al. (2017) conducted a cohort in Verapamil-sensitive idiopathic left ventricular tachycardia (n=80). Spontaneous elimination of VT (VT[-]) vs. Recurrence of VT (VT[+]) was evaluated on Change in QRS duration (ΔQRS-d) in patients without radiofrequency catheter ablation (p=0.002). Spontaneous elimination of verapamil-sensitive idiopathic left ventricular tachycardia without ablation was associated with significantly larger changes in QRS duration (30 vs 6 ms, P=0.002).
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