title: Non-Reentrant Fascicular Tachycardia: Clinical and Electrophysiological Characteristics of a Distinct Type of Idiopathic Ventricular Tachycardia.
abstract: BACKGROUND
  The most common form of idiopathic Purkinje-related ventricular tachycardia (VT) is the reentrant type. We describe the clinical and electrophysiological characteristics of focal non-reentrant fascicular tachycardia.
  
  
  RESULTS
  Among 530 idiopathic VT patients who were referred for ablation, we identified 15 (2.8%) with non-reentrant fascicular tachycardia (11 men, 45±21 years). Sinus rhythm ECG showed normal conduction intervals with a His-ventricular interval of 41±4 ms. All patients had monomorphic VT (cycle length: 337±88 ms) with a relatively narrow QRS (123±12 ms), and they did not respond to verapamil during the initial presentation. VT exhibited right bundle-branch block/superior axis configuration in 11 patients (73%) and inferior axis in 3 (20%). In 1 patient (7%), VT exhibited left bundle-branch block/superior axis configuration. During ablation, spontaneous VT occurred in 3 patients (20%) and nonentraintable VT or identical premature ventricular complex was induced in 9 (60%). A high-frequency presystolic Purkinje potential was recorded during VT/premature ventricular complex, preceding the QRS by 25±16 ms. VT recurrence was observed in 4 patients (27%), and among them, 3 underwent pacemap-guided ablation during the first session. A second ablation with activation mapping guidance eliminated the VT during the 88±8-month follow-up.
  
  
  CONCLUSIONS
  Among idiopathic VT cases referred for ablation, 2.8% were focal non-reentrant fascicular tachycardia, which had distinct clinical characteristics and usually originated from the left posterior fascicle, and less commonly from the left anterior fascicle and right ventricular Purkinje network. Catheter ablation is effective, whereas pacemap-guided approach is less efficacious.
authors.affiliation: From the Cardiovascular Division, Faculty of Medicine, Tsukuba University, Japan (A.K.T., A.N., K.K., M.I., Y.S., K.A.); Department of Cardiology, Ogaki Municipal Hospital, Japan (I.M.); and Department of Heart Rhythm Management, Yokohama Rosai Hospital, Kanagawa, Japan (Y.O., S.K., Y.K., K.K.).
authors.forename: Ahmed Karim
authors.initials: AK
authors.lastname: Talib
authors.affiliation: From the Cardiovascular Division, Faculty of Medicine, Tsukuba University, Japan (A.K.T., A.N., K.K., M.I., Y.S., K.A.); Department of Cardiology, Ogaki Municipal Hospital, Japan (I.M.); and Department of Heart Rhythm Management, Yokohama Rosai Hospital, Kanagawa, Japan (Y.O., S.K., Y.K., K.K.). akihiko-ind@umin.ac.jp.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Nogami
authors.affiliation: From the Cardiovascular Division, Faculty of Medicine, Tsukuba University, Japan (A.K.T., A.N., K.K., M.I., Y.S., K.A.); Department of Cardiology, Ogaki Municipal Hospital, Japan (I.M.); and Department of Heart Rhythm Management, Yokohama Rosai Hospital, Kanagawa, Japan (Y.O., S.K., Y.K., K.K.).
authors.forename: Itsuro
authors.initials: I
authors.lastname: Morishima
authors.affiliation: From the Cardiovascular Division, Faculty of Medicine, Tsukuba University, Japan (A.K.T., A.N., K.K., M.I., Y.S., K.A.); Department of Cardiology, Ogaki Municipal Hospital, Japan (I.M.); and Department of Heart Rhythm Management, Yokohama Rosai Hospital, Kanagawa, Japan (Y.O., S.K., Y.K., K.K.).
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Oginosawa
authors.affiliation: From the Cardiovascular Division, Faculty of Medicine, Tsukuba University, Japan (A.K.T., A.N., K.K., M.I., Y.S., K.A.); Department of Cardiology, Ogaki Municipal Hospital, Japan (I.M.); and Department of Heart Rhythm Management, Yokohama Rosai Hospital, Kanagawa, Japan (Y.O., S.K., Y.K., K.K.).
authors.forename: Kenji
authors.initials: K
authors.lastname: Kurosaki
authors.affiliation: From the Cardiovascular Division, Faculty of Medicine, Tsukuba University, Japan (A.K.T., A.N., K.K., M.I., Y.S., K.A.); Department of Cardiology, Ogaki Municipal Hospital, Japan (I.M.); and Department of Heart Rhythm Management, Yokohama Rosai Hospital, Kanagawa, Japan (Y.O., S.K., Y.K., K.K.).
authors.forename: Shinya
authors.initials: S
authors.lastname: Kowase
authors.affiliation: From the Cardiovascular Division, Faculty of Medicine, Tsukuba University, Japan (A.K.T., A.N., K.K., M.I., Y.S., K.A.); Department of Cardiology, Ogaki Municipal Hospital, Japan (I.M.); and Department of Heart Rhythm Management, Yokohama Rosai Hospital, Kanagawa, Japan (Y.O., S.K., Y.K., K.K.).
authors.forename: Yuki
authors.initials: Y
authors.lastname: Komatsu
authors.affiliation: From the Cardiovascular Division, Faculty of Medicine, Tsukuba University, Japan (A.K.T., A.N., K.K., M.I., Y.S., K.A.); Department of Cardiology, Ogaki Municipal Hospital, Japan (I.M.); and Department of Heart Rhythm Management, Yokohama Rosai Hospital, Kanagawa, Japan (Y.O., S.K., Y.K., K.K.).
authors.forename: Kenji
authors.initials: K
authors.lastname: Kuroki
authors.affiliation: From the Cardiovascular Division, Faculty of Medicine, Tsukuba University, Japan (A.K.T., A.N., K.K., M.I., Y.S., K.A.); Department of Cardiology, Ogaki Municipal Hospital, Japan (I.M.); and Department of Heart Rhythm Management, Yokohama Rosai Hospital, Kanagawa, Japan (Y.O., S.K., Y.K., K.K.).
authors.forename: Miyako
authors.initials: M
authors.lastname: Igarashi
authors.affiliation: From the Cardiovascular Division, Faculty of Medicine, Tsukuba University, Japan (A.K.T., A.N., K.K., M.I., Y.S., K.A.); Department of Cardiology, Ogaki Municipal Hospital, Japan (I.M.); and Department of Heart Rhythm Management, Yokohama Rosai Hospital, Kanagawa, Japan (Y.O., S.K., Y.K., K.K.).
authors.forename: Yukio
authors.initials: Y
authors.lastname: Sekiguchi
authors.affiliation: From the Cardiovascular Division, Faculty of Medicine, Tsukuba University, Japan (A.K.T., A.N., K.K., M.I., Y.S., K.A.); Department of Cardiology, Ogaki Municipal Hospital, Japan (I.M.); and Department of Heart Rhythm Management, Yokohama Rosai Hospital, Kanagawa, Japan (Y.O., S.K., Y.K., K.K.).
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Aonuma
mesh_terms: D002036:Bundle of His / Q000503:physiopathology; D002037:Bundle-Branch Block / Q000503:physiopathology; D017115:Catheter Ablation / Q000379:methods*; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011690:Purkinje Fibers / Q000503:physiopathology; D012008:Recurrence; D017180:Tachycardia, Ventricular / Q000503:physiopathology* / Q000601:surgery*; D016896:Treatment Outcome; D018879:Ventricular Premature Complexes / Q000503:physiopathology
keywords: Purkinje; catheter ablation; fascicular ventricular tachycardia; verpamil