title: Radiofrequency ablation of idiopathic left anterior fascicular tachycardia.
abstract: BACKGROUND
  A 45-year-old man with idiopathic ventricular tachycardia (VT) having a right bundle branch block configuration with right-axis deviation underwent an electrophysiologic test.
  
  
  RESULTS
  Mapping demonstrated a site on the anterobasal wall of the left ventricle where there was an excellent pace map and an endocardial activation time of -20 msec, but radiofrequency catheter ablation at this site was unsuccessful. At a nearby site, a presumed Purkinje potential preceded the by 30 msec during VT and sinus rhythm, and catheter ablation was effective despite a poor pace map and an endocardial ventricular activation time of zero.
  
  
  CONCLUSIONS
  Idiopathic VT with a right bundle branch configuration and right-axis deviation may originate in the area of the left anterior fascicle. A potential presumed to represent a Purkinje potential may be more helpful than endocardial ventricular activation mapping or pace mapping in guiding ablation of this type of VT.
authors.affiliation: Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, USA.
authors.forename: F
authors.initials: F
authors.lastname: Bogun
authors.forename: R
authors.initials: R
authors.lastname: El-Atassi
authors.forename: E
authors.initials: E
authors.lastname: Daoud
authors.forename: K C
authors.initials: KC
authors.lastname: Man
authors.forename: S A
authors.initials: SA
authors.lastname: Strickberger
authors.forename: F
authors.initials: F
authors.lastname: Morady
mesh_terms: D017115:Catheter Ablation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011690:Purkinje Fibers / Q000503:physiopathology; D017180:Tachycardia, Ventricular / Q000503:physiopathology / Q000601:surgery*