Key result
RF ablation eliminates ILVT following an initial QRS axis shift from left to right.
Case Report (n=1)
No
This case demonstrates that radiofrequency ablation of the left posterior fascicle can cause a shift in QRS axis without terminating the tachycardia due to conduction block distal to the reentry circuit.
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May guide fascicular VT ablation after QRS axis shift; hypothesis-generating and requires confirmation in larger series.
A 62 year-old-woman presented with a right bundle branch block (RBBB) and left axis deviation (LAD) tachycardia. Radiofrequency (RF) energy was delivered to the left posterior fascicle (LPF) where 2 presystolic Purkinje potentials (P1 and P2) preceding onset of the QRS complex were recorded. During RF energy applications, the QRS morphology of the tachycardia changed from RBBB and LAD to RBBB and right axis deviation without termination of the tachycardia. The Purkinje potential was observed following the QRS complex during the tachycardia because of conduction block of the LPF distal to the reentry circuit due to RF catheter ablation.
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Okumura et al. (2006) conducted a case report in Idiopathic left ventricular tachycardia (n=1). Radiofrequency catheter ablation was evaluated on Elimination of tachycardia. Radiofrequency catheter ablation successfully eliminated idiopathic left ventricular tachycardia after an initial application caused a change in QRS morphology from left to right axis deviation.
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