Key result
Proximal LPF ablation successfully treats recurrent US-VT without causing further branch block.
Why the study?
Upper septal ventricular tachycardia is likely in patients with prior left posterior fascicular VT ablation, but little is known about its recurrence mechanism.
Case Report (n=1)
In patients with recurrent upper septal VT after LPF-VT ablation, targeting the earliest pre-systolic potential (P2) site of the original LPF-VT can successfully eliminate the recurrence.
US-VT may recur after LPF-VT ablation; leaves open the mechanism and optimal ablation strategy.
BACKGROUND: Verapamil-sensitive fascicular ventricular tachycardia (VT) is the most common type of idiopathic left ventricular tachycardia, and it is divided into three types. Upper septal ventricular tachycardia (US-VT) is likely in patients with prior episodes of left posterior fascicular (LPF)-VT ablation, however, little is known about the recurrence mechanism of US-VT. CASE SUMMARY: A 53-year-old man had an US-VT after two catheter ablation sessions for a common idiopathic LPF-VT. The US-VT was successfully treated by ablating the proximal site of the LPF without making any further branch or fascicular block. This successful ablation point corresponded completely with the earliest pre-systolic potential (P2) site of the LPF-VT during the 1st session of catheter ablation. DISCUSSION: An US-VT recurrence could occur if a critical slow conduction is not affected by the catheter ablation. This recurrence might be the result of changing the re-entrant circuit after damage to the LPF. In order to eliminate the LPF-VT and prevent an US-VT recurrence, the earliest P2 site should be investigated carefully and ablated sufficiently.
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Yamaguchi et al. (2019) conducted a case report in Upper septal ventricular tachycardia (n=1). Catheter ablation of the proximal site of the left posterior fascicle was evaluated on Successful treatment of US-VT. Catheter ablation of the proximal site of the left posterior fascicle successfully treated recurrent upper septal ventricular tachycardia without causing further branch block.
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