Key result
Repeat catheter ablation maintains sinus rhythm for ~14 months in refractory posterior fascicular VT.
Case Report (n=1)
Catheter ablation targeting the posterior fascicle can successfully eliminate recurrent, treatment-resistant posterior fascicular ventricular tachycardia in patients failing medical therapy.
Answers are grounded in this paper and cite their sources.
May support repeat posterior fascicle ablation in refractory fascicular VT; leaves open confirmation in prospective studies.
Fascicular ventricular tachycardia (VT) is a form of VT that arises through a re-entrant pathway utilising the Purkinje fibres. It can be categorised based on the anatomical origin of the re-entrant pathway. Fascicular VT typically affects young males. We present a case of a young male patient with treatment-resistant fascicular VT. A young male in his twenties spent much of his adolescence (8 years) suffering from sudden-onset and offset 'panic attack'-like symptoms. A routine preoperative ECG showed posterior fascicular VT. After a poor response to medical therapy, the patient underwent two catheter ablation procedures, with a final good symptomatic outcome. Fascicular VT is often difficult to diagnose and can be misinterpreted as supraventricular tachycardia (SVT) given the narrow QRS. The mainstay of medical management is verapamil; however, more invasive treatments such as catheter ablation are available, yielding high success rates.
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Abotabekh et al. (2026) conducted a case report in Treatment-resistant posterior fascicular ventricular tachycardia (n=1). Catheter ablation was evaluated on Freedom from recurrent VT. A second catheter ablation targeting the posterior fascicle successfully maintained sinus rhythm for 14 months in a young male with treatment-resistant posterior fascicular ventricular tachycardia.
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