title: Catheter Ablation of Fascicular Ventricular Tachycardia: Long-Term Clinical Outcomes and Mechanisms of Recurrence.
abstract: BACKGROUND
  Fascicular ventricular tachycardia (FVT) is a common form of sustained idiopathic left ventricular tachycardia with an Asian preponderance. This study aimed to prospectively investigate long-term clinical outcomes of patients undergoing ablation of FVT and identify predictors of arrhythmia recurrence.
  
  
  RESULTS
  Consecutive patients undergoing FVT ablation at a single tertiary center were enrolled. Activation mapping was performed to identify the earliest presystolic Purkinje potential during FVT that was targeted by radiofrequency ablation. Follow-up with clinic visits, ECG, and Holter monitoring was performed at least every 6 months. A total of 120 consecutive patients (mean age, 29.3±12.7 years; 82% men; all patients with normal ejection fraction) were enrolled. FVT involved left posterior fascicle and left anterior fascicle in 118 and 2 subjects, respectively. VT was noninducible in 3 patients, and ablation was acutely successful in 117 patients. With a median follow-up of 55.7 months, VT of a similar ECG morphology recurred in 17 patients, and repeat procedure confirmed FVT recurrence involving the same fascicle. Shorter VT cycle length was the only significant predictor of FVT recurrence (P=0.03). Six other patients developed new-onset upper septal FVT that was successfully ablated.
  
  
  CONCLUSIONS
  Ablation of FVT guided by activation mapping is associated with a single procedural success rate without the use of antiarrhythmic drugs of 80.3%. Arrhythmia recurrences after an initially successful ablation were caused by recurrent FVT involving the same fascicle in two thirds of patients or new onset of upper septal FVT in the remainder.
authors.affiliation: From the Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China (Y.L., Z.F., B.Y., H.C., W.J., K.C., M.C., F.Z.); and Heart Center, National University Hospital, Singapore, Singapore (P.K.).
authors.forename: Yaowu
authors.initials: Y
authors.lastname: Liu
authors.affiliation: From the Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China (Y.L., Z.F., B.Y., H.C., W.J., K.C., M.C., F.Z.); and Heart Center, National University Hospital, Singapore, Singapore (P.K.).
authors.forename: Zhen
authors.initials: Z
authors.lastname: Fang
authors.affiliation: From the Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China (Y.L., Z.F., B.Y., H.C., W.J., K.C., M.C., F.Z.); and Heart Center, National University Hospital, Singapore, Singapore (P.K.).
authors.forename: Bing
authors.initials: B
authors.lastname: Yang
authors.affiliation: From the Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China (Y.L., Z.F., B.Y., H.C., W.J., K.C., M.C., F.Z.); and Heart Center, National University Hospital, Singapore, Singapore (P.K.).
authors.forename: Pipin
authors.initials: P
authors.lastname: Kojodjojo
authors.affiliation: From the Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China (Y.L., Z.F., B.Y., H.C., W.J., K.C., M.C., F.Z.); and Heart Center, National University Hospital, Singapore, Singapore (P.K.).
authors.forename: Hongwu
authors.initials: H
authors.lastname: Chen
authors.affiliation: From the Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China (Y.L., Z.F., B.Y., H.C., W.J., K.C., M.C., F.Z.); and Heart Center, National University Hospital, Singapore, Singapore (P.K.).
authors.forename: Weizhu
authors.initials: W
authors.lastname: Ju
authors.affiliation: From the Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China (Y.L., Z.F., B.Y., H.C., W.J., K.C., M.C., F.Z.); and Heart Center, National University Hospital, Singapore, Singapore (P.K.).
authors.forename: Kejiang
authors.initials: K
authors.lastname: Cao
authors.affiliation: From the Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China (Y.L., Z.F., B.Y., H.C., W.J., K.C., M.C., F.Z.); and Heart Center, National University Hospital, Singapore, Singapore (P.K.).
authors.forename: Minglong
authors.initials: M
authors.lastname: Chen
authors.affiliation: From the Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China (Y.L., Z.F., B.Y., H.C., W.J., K.C., M.C., F.Z.); and Heart Center, National University Hospital, Singapore, Singapore (P.K.). njzfx6@njmu.edu.cn.
authors.forename: Fengxiang
authors.initials: F
authors.lastname: Zhang
mesh_terms: D000200:Action Potentials; D000293:Adolescent; D000328:Adult; D002036:Bundle of His / Q000503:physiopathology / Q000601:surgery*; D002304:Cardiac Pacing, Artificial; D017115:Catheter Ablation / Q000009:adverse effects*; D002681:China; D015716:Electrocardiography, Ambulatory; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: bundle of His; catheter ablation; follow-up studies; recurrence; tachycardia, ventricular