The observation of retrograde Purkinje potential activation after ablation suggests that a large reentry circuit involving Purkinje tissue with decremental properties is the mechanism for idiopathic left ventricular tachycardia.
Hypothesis-generating for Purkinje macroreentry in ILVT; does not support practice change without prospective confirmation.
We describe two patients with idiopathic left ventricular tachycardia that were cured by radiofrequency catheter ablation. Tachycardia was inducible by ventricular stimulation and was verapamil sensitive. Two distinct presystolic potentials (P1 and P2) were recorded during tachycardia in the mid-septal or inferoapical area, but only one potential (P2) was recorded during sinus rhythm. After catheter ablation at this site, the P1 potential was noted after the QRS complex during sinus rhythm, while the P2 was still observed before the QRS complex. The P1 potential showed a decremental property during atrial or ventricular pacing. These data suggest that Purkinje tissue with decremental properties was responsible for the tachycardia mechanism, and that the reentry circuit involving this tissue is likely to be of considerable size.
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Tada et al. (1998) studied this question.
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