Key result
Left posterior fascicle ablation terminated bundle branch reentrant ventricular tachycardia in 1 patient, resulting in complete atrioventricular block.
Case Report (n=1)
This case highlights a rare presentation of bundle branch reentrant ventricular tachycardia with two distinct conduction patterns in a patient with complete RBBB, where sequential fascicle ablation terminated the arrhythmia but resulted in complete AV block.
Risk of complete AV block warrants caution with left posterior fascicle ablation for bundle branch reentrant VT; hypothesis-generating for alternative targets in rare conduction patterns.
We report a rare case of bundle branch reentrant ventricular tachycardia [BBRVT]. A 67-year-old female was admitted for management of wide QRS tachycardia (right bundle branch block [RBBB] and a southwest axis). The mapping procedure revealed the tachycardia circuit consisted of the left anterior fascicle (LAF) as an antegrade, and the right bundle as a retrograde pathway. She presented RBBB during sinus rhythm. LAF ablation changed the tachycardia configuration to a northwest axis and prolonged the cycle length. Left posterior fascicle ablation terminated the tachycardia, and complete atrioventricular block occurred, which showed the unidirectional conduction over the right bundle.
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Enjoji et al. (2006) conducted a case report in Bundle branch reentrant ventricular tachycardia (n=1). Left anterior and left posterior fascicle ablation was evaluated. Left posterior fascicle ablation terminated bundle branch reentrant ventricular tachycardia in 1 patient, resulting in complete atrioventricular block.
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