Key result
Radiofrequency catheter ablation successfully terminated an upper septal variant of idiopathic left ventricular tachycardia that transitioned from a left posterior fascicular variant during the procedure, with no recurrence at 16 months.
Case Report (n=1)
No
Catheter ablation of the left posterior fascicle for common idiopathic left ventricular tachycardia can result in transformation to the rare upper septal variant, which can be successfully ablated by targeting the mid-anterior interventricular septum.
Successful ablation feasible in rare transitioning upper septal fascicular VT; extends ILVT variant classification but leaves optimal mapping open.
Verapamil-sensitive fascicular ventricular tachycardia (VT) is the commonest form of idiopathic left ventricular tachycardia (ILVT).1 The characteristic diagnostic features of fascicular ILVT include: (i) induction with atrial pacing, (ii) right bundle branch block (RBBB) with left-axis deviation morphology during VT, (iii) absence of structural heart disease, and (iv) verapamil sensitivity.2,3 Fascicular ILVTs are classified according to the QRS morphology into 3 subtypes: (i) left posterior fascicular (LPF) VT, exhibiting an RBBB with left-axis deviation electrocardiogram (ECG) pattern (90% of all fascicular ILVT); (ii) left anterior fascicular VT, exhibiting an RBBB with right-axis deviation ECG pattern (10% of all fascicular ILVT); and (iii) upper septal (US) fascicular VT, exhibiting a narrow QRS pattern with normal or right-axis deviation (very rare; <1% of all ILVT).
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Nair et al. (2015) conducted a case report in Verapamil-sensitive idiopathic left ventricular tachycardia (n=1). Radiofrequency catheter ablation was evaluated on Termination of tachycardia and freedom from recurrence. Radiofrequency catheter ablation successfully terminated an upper septal variant of idiopathic left ventricular tachycardia that transitioned from a left posterior fascicular variant during the procedure, with no recurrence at 16 months.
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