Key result
Catheter ablation of the ectopic focus in a 15-year-old with ventricular parasystole from the left posterior fascicle successfully eliminated recurrent syncope symptoms.
Case Report (n=1)
Catheter ablation of a fascicular parasystolic focus can successfully treat recurrent syncope in patients at risk of parasystole-induced tachyarrhythmia.
Ablation may resolve syncope from fascicular parasystole; hypothesis-generating and requires prospective validation before broader use.
INTRODUCTION: Parasystole refers to an ectopic pacemaker that discharges with a constant rate competing with the primary pacemaker of the heart the sinus node. Parasystolic pacemakers have been described in the atrium, atrioventricular node, His bundle, and in the ventricle. Ventricular parasystole usually carries a benign prognosis, but there are a few reports of ventricular tachyarrhythmia initiated by parasystolic beats. CASE PRESENTATION: We present a case of a 15-year-old otherwise healthy teenager with recurrent most likely arrhythmic syncope who was diagnosed with ventricular parasystole from the left posterior fascicle. After exclusion of structural and primary electrical heart disease, the patient was deemed at increased risk of parasystole-induced tachyarrhythmia, and thus catheter ablation of the ectopic focus was performed. Since catheter ablation the patient continues to be free of any symptoms. DISCUSSION: This report highlights the potential risks of parasystole in context of recurrent syncope and reviews the available literature on parasystole and ventricular tachyarrhythmia.
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Steinfurt et al. (2018) conducted a case report in Ventricular parasystole and recurrent syncope (n=1). Catheter ablation was evaluated on Freedom from symptoms. Catheter ablation of the ectopic focus in a 15-year-old with ventricular parasystole from the left posterior fascicle successfully eliminated recurrent syncope symptoms.
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