Long-term outcome after catheter ablation for left posterior fascicular ventricular tachycardia without development of left posterior fascicular block.
BACKGROUND
Catheter ablation of left posterior fascicular (LPF) ventricular tachycardia (VT) is commonly performed during tachycardia. This study reports on the long-term outcome of patients undergoing ablation of LPF VT targeting the earliest retrograde activation within the posterior Purkinje fiber network during sinus rhythm (SR).


METHODS
This study retrospectively analyzed 24 consecutive patients (8 female; mean age 26 ± 11 years) referred for catheter ablation of electrocardiographically documented LPF VT. Programmed stimulation was performed to induce tachycardia, while mapping and ablation was aided by use of a 3D electroanatomical mapping system. Catheter ablation targeted the earliest potential suggestive of retrograde activation within the posterior Purkinje fiber network (retro-PP) recorded along the posterior mid-septal left ventricle during SR if LPF VT was noninducible.


RESULTS
Overall, 21/24 (87.5%) patients underwent successful catheter ablation in SR targeting the earliest retro-PP, while 3/24 (12.5%) patients were successfully ablated during tachycardia. In none of the patients, ablation resulted in LPF block. No procedure-related complications occurred. After a median follow-up period of 8.9 (4.8-10.9) years, 22/24 (92%) patients were free from recurrent VT.


CONCLUSIONS
In patients presenting with LPF VT, ablation of the earliest retro-PP along the posterior mid-septal LV during SR results in excellent long-term outcome during a median follow-up period of almost 9 years.
e.wissner@asklepios.com
Erik
E
Wissner
S Yamkumar Divakara
SY
Menon
Andreas
A
Metzner
Bas
B
Schoonderwoerd
Dieter
D
Nuyens
Hisaki
H
Makimoto
Qingying
Q
Zhang
Shibu
S
Mathew
Alexander
A
Fuernkranz
Andreas
A
Rillig
Roland Richard
RR
Tilz
Karl-Heinz
KH
Kuck
Feifan
F
Ouyang
D000293:Adolescent; D000328:Adult; D002037:Bundle-Branch Block / Q000209:etiology; D002304:Cardiac Pacing, Artificial; D017115:Catheter Ablation / Q000009:adverse effects; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006801:Humans; D008297:Male; D011690:Purkinje Fibers / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult