Radiofrequency ablation of idiopathic left anterior fascicular tachycardia.
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.
Bogun
F
F
Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, USA.
El-Atassi
R
R
Daoud
E
E
Man
K C
KC
Strickberger
S A
SA
Morady
F
F
D017115:Catheter Ablation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011690:Purkinje Fibers / Q000503:physiopathology; D017180:Tachycardia, Ventricular / Q000503:physiopathology / Q000601:surgery*