Ablation of left posterior fascicular ventricular tachycardia during sinus rhythm under guidance of non-contact balloon mapping

This paper evaluated the effectiveness and safety of patchy ablation for treating left posterior fascicular ventricular tachycardia (LPFVT) using rapid mapping of diastolic potentials and Purkinje potentials during sinus rhythm under the guidance of the Ensite3000 system. Twelve patients suffering from left posterior fascicular ventricular tachycardia were treated at our center. A three-dimensional endocardium geometric model was established under the guidance of the Ensite3000 balloon mapping system during sinus rhythm. The patchy ablation was induced by the diastolic potential (DP) and Purkinje potential (PP) at the top region of the sinus rhythm breakout point (SNR-BO). The conduction block in the left posterior branch was observed on the surface electrocardiograms of 11 patients. Ventricular tachycardia could not be induced in any of these patients by programmed stimulation following ablation. At follow-up, only one patient had relapsed (two months after the operation) and ventricular tachycardia could not be induced after re-ablation. Left posterior fascicular ventricular tachycardia can be treated effectively and safely by marking the left posterior fascicular under the guidance of the Ensite3000 non-contact balloon mapping system. The technique allowed for accurate mapping of the PP and the DP as targets for patchy ablation between the SNR-BO and atrioventricular bundle, and the identification of the ablation end point at the time when the conduction block of left posterior branch occurred on the surface electrocardiogram.