title: Insights into the mechanism of idiopathic left ventricular tachycardia: a case report and literature review.
abstract: Left ventricular posterior fascicular tachycardia (LVPFT) is an idiopathic form of VT characterized by right bundle branch block morphology and left axis deviation. The mechanism of LPFVT is thought to be localized reentry close to the posterior fascicle. We present the case of a 24-year-old medical student who was admitted to the emergency department complaining of palpitations. The ECG showed an aspect suggestive of LVPFT. Vagal maneuvers, adenosine and i.v. Metoprolol were ineffective in terminating the arrhythmia. Conversion to sinus rhythm was obtained 10 h later, with i.v Amiodarone. The ECG in sinus rhythm showed left posterior fascicular block. Because antiarrhythmic drugs were not desired by the patient, VT ablation was proposed. The electrophysiological study identified the mechanism of arrhythmia to be reentry using the slowly conducting verapamil-sensitive fibers as the antegrade limb and the posterior fascicle as the retrograde limb. Radiofrequency applications near the posterior fascicle, in the lower half of the interventricular septum, at the junction of the two proximal thirds with the distal third interrupted the tachycardia and made it non-inducible at programmed stimulation. The case is unusual as the patient had a left posterior fascicular block during sinus rhythm before ablation. This demonstrates that the reentry circuit of VT does not need antegrade conduction through the posterior fascicle for perpetuation.
authors.affiliation: Department of Cardiology, Rehabilitation Hospital, "Iuliu Hatieganu" University of Medicine and Pharmacy, 46-50 Viilor Street, 400347, Cluj-Napoca, Romania. puie_paul@yahoo.com.
authors.forename: Paul
authors.initials: P
authors.lastname: Puie
authors.affiliation: Department of Cardiology, Rehabilitation Hospital, "Iuliu Hatieganu" University of Medicine and Pharmacy, 46-50 Viilor Street, 400347, Cluj-Napoca, Romania. gabi_cismaru@yahoo.com.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Cismaru
authors.affiliation: Department of Cardiology, Rehabilitation Hospital, "Iuliu Hatieganu" University of Medicine and Pharmacy, 46-50 Viilor Street, 400347, Cluj-Napoca, Romania. lmure_san@yahoo.com.
authors.forename: Lucian
authors.initials: L
authors.lastname: Muresan
authors.affiliation: Department of Cardiology, Rehabilitation Hospital, "Iuliu Hatieganu" University of Medicine and Pharmacy, 46-50 Viilor Street, 400347, Cluj-Napoca, Romania. rosu.radu1053@gmail.com.
authors.forename: Radu
authors.initials: R
authors.lastname: Rosu
authors.affiliation: Department of Cardiology, Rehabilitation Hospital, "Iuliu Hatieganu" University of Medicine and Pharmacy, 46-50 Viilor Street, 400347, Cluj-Napoca, Romania. puiu.mihai@yahoo.com.
authors.forename: Mihai
authors.initials: M
authors.lastname: Puiu
authors.affiliation: Department of Electrophysiology, Institut Lorrain du Coeur et des Vaisseaux «Louis Mathieu», CHU de Nancy, Cluj-Napoca, France. marius53fr@yahoo.fr.
authors.forename: Marius
authors.initials: M
authors.lastname: Andronache
authors.affiliation: Department of Cardiology, Rehabilitation Hospital, "Iuliu Hatieganu" University of Medicine and Pharmacy, 46-50 Viilor Street, 400347, Cluj-Napoca, Romania. gusetu@gmail.com.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Gusetu
authors.affiliation: Department of Cardiology, Rehabilitation Hospital, "Iuliu Hatieganu" University of Medicine and Pharmacy, 46-50 Viilor Street, 400347, Cluj-Napoca, Romania. roxanamatuz@yahoo.com.
authors.forename: Roxana
authors.initials: R
authors.lastname: Matuz
authors.affiliation: Department of Internal Medicine, Medical Clinic No 1, "Iuliu Hatieganu", University of Medicine and Pharmacy, Cluj-Napoca, Romania. pmircea@umfcluj.ro.
authors.forename: Petru-Adrian
authors.initials: PA
authors.lastname: Mircea
authors.affiliation: Department of Cardiology, Rehabilitation Hospital, "Iuliu Hatieganu" University of Medicine and Pharmacy, 46-50 Viilor Street, 400347, Cluj-Napoca, Romania. pop67dana@gmail.com.
authors.forename: Dana
authors.initials: D
authors.lastname: Pop
authors.affiliation: Department of Cardiology, Rehabilitation Hospital, "Iuliu Hatieganu" University of Medicine and Pharmacy, 46-50 Viilor Street, 400347, Cluj-Napoca, Romania. dzdrenghea@yahoo.com.
authors.forename: Dumitru
authors.initials: D
authors.lastname: Zdrenghea
mesh_terms: D000328:Adult; D006801:Humans; D008297:Male; D017180:Tachycardia, Ventricular / Q000209:etiology*; D055815:Young Adult