title: Fascicular Ventricular Tachycardia Originating From Papillary Muscles: Purkinje Network Involvement in the Reentrant Circuit.
abstract: BACKGROUND
  Verapamil-sensitive fascicular ventricular tachycardia (FVT) has been demonstrated to be a reentrant mechanism using the Purkinje network as a part of its reentrant circuit. Although the papillary muscles (PMs) are implicated in arrhythmogenic structure, reentrant FVT originating from the PMs has not been well defined.
  
  
  RESULTS
  We studied 13 patients in whom FVT was successfully eliminated by ablation at the posterior PMs (n=8; PPM-FVT) and anterior PMs (n=5; APM-FVT). Although intravenous administration of verapamil (5 mg) terminated ventricular tachycardia (VT) in 6 patients, VT was only slowed in the remaining 7 patients. PPM-FVT exhibited right bundle branch block and superior right axis (extreme right axis) or horizontal axis deviation. APM-FVT exhibited right bundle branch block configuration and right axis deviation with deep S wave in leads I, V5, and V6. VT was reproducibly induced by programmed atrial or ventricular stimulation. His-ventricular interval during VT was shorter than that during sinus rhythm. Ablation at the left posterior or anterior fascicular regions often changed the QRS morphology but did not completely eliminate it. Mid-diastolic Purkinje potentials were recorded during VT around the PMs, where ablation successfully eliminated the tachycardia. All patients have been free from recurrent VT after ablation.
  
  
  CONCLUSIONS
  Reentrant circuit of verapamil-sensitive FVT can involve the Purkinje network lying around the PMs. PM-FVT is a distinct entity that is characterized by distinctive electrocardiographic characteristics and less sensitivity to verapamil administration compared with common type FVT. Ablation targeting the mid-diastolic Purkinje potentials around the PMs during tachycardia can be effective in suppressing this arrhythmia.
authors.affiliation: From the Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Japan (Y.K., A.N., K.M., A.K.T., K.A., Y. Shinoda, Y. Sekiguchi); Department of Heart Rhythm Management, Yokohama Rosai Hospital, Japan (K.K., Y.H., S.K.); Department of Cardiology, Ogaki Municipal Hospital, Japan (I.M.); Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Japan (T.O.); and Department of Cardiology and Hematology, Fukushima Medical University, Japan (T.K.).
authors.forename: Yuki
authors.initials: Y
authors.lastname: Komatsu
authors.affiliation: From the Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Japan (Y.K., A.N., K.M., A.K.T., K.A., Y. Shinoda, Y. Sekiguchi); Department of Heart Rhythm Management, Yokohama Rosai Hospital, Japan (K.K., Y.H., S.K.); Department of Cardiology, Ogaki Municipal Hospital, Japan (I.M.); Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Japan (T.O.); and Department of Cardiology and Hematology, Fukushima Medical University, Japan (T.K.). akihiko-ind@umin.ac.jp.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Nogami
authors.affiliation: From the Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Japan (Y.K., A.N., K.M., A.K.T., K.A., Y. Shinoda, Y. Sekiguchi); Department of Heart Rhythm Management, Yokohama Rosai Hospital, Japan (K.K., Y.H., S.K.); Department of Cardiology, Ogaki Municipal Hospital, Japan (I.M.); Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Japan (T.O.); and Department of Cardiology and Hematology, Fukushima Medical University, Japan (T.K.).
authors.forename: Kenji
authors.initials: K
authors.lastname: Kurosaki
authors.affiliation: From the Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Japan (Y.K., A.N., K.M., A.K.T., K.A., Y. Shinoda, Y. Sekiguchi); Department of Heart Rhythm Management, Yokohama Rosai Hospital, Japan (K.K., Y.H., S.K.); Department of Cardiology, Ogaki Municipal Hospital, Japan (I.M.); Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Japan (T.O.); and Department of Cardiology and Hematology, Fukushima Medical University, Japan (T.K.).
authors.forename: Itsuro
authors.initials: I
authors.lastname: Morishima
authors.affiliation: From the Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Japan (Y.K., A.N., K.M., A.K.T., K.A., Y. Shinoda, Y. Sekiguchi); Department of Heart Rhythm Management, Yokohama Rosai Hospital, Japan (K.K., Y.H., S.K.); Department of Cardiology, Ogaki Municipal Hospital, Japan (I.M.); Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Japan (T.O.); and Department of Cardiology and Hematology, Fukushima Medical University, Japan (T.K.).
authors.forename: Keita
authors.initials: K
authors.lastname: Masuda
authors.affiliation: From the Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Japan (Y.K., A.N., K.M., A.K.T., K.A., Y. Shinoda, Y. Sekiguchi); Department of Heart Rhythm Management, Yokohama Rosai Hospital, Japan (K.K., Y.H., S.K.); Department of Cardiology, Ogaki Municipal Hospital, Japan (I.M.); Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Japan (T.O.); and Department of Cardiology and Hematology, Fukushima Medical University, Japan (T.K.).
authors.forename: Tomoya
authors.initials: T
authors.lastname: Ozawa
authors.affiliation: From the Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Japan (Y.K., A.N., K.M., A.K.T., K.A., Y. Shinoda, Y. Sekiguchi); Department of Heart Rhythm Management, Yokohama Rosai Hospital, Japan (K.K., Y.H., S.K.); Department of Cardiology, Ogaki Municipal Hospital, Japan (I.M.); Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Japan (T.O.); and Department of Cardiology and Hematology, Fukushima Medical University, Japan (T.K.).
authors.forename: Takashi
authors.initials: T
authors.lastname: Kaneshiro
authors.affiliation: From the Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Japan (Y.K., A.N., K.M., A.K.T., K.A., Y. Shinoda, Y. Sekiguchi); Department of Heart Rhythm Management, Yokohama Rosai Hospital, Japan (K.K., Y.H., S.K.); Department of Cardiology, Ogaki Municipal Hospital, Japan (I.M.); Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Japan (T.O.); and Department of Cardiology and Hematology, Fukushima Medical University, Japan (T.K.).
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Hanaki
authors.affiliation: From the Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Japan (Y.K., A.N., K.M., A.K.T., K.A., Y. Shinoda, Y. Sekiguchi); Department of Heart Rhythm Management, Yokohama Rosai Hospital, Japan (K.K., Y.H., S.K.); Department of Cardiology, Ogaki Municipal Hospital, Japan (I.M.); Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Japan (T.O.); and Department of Cardiology and Hematology, Fukushima Medical University, Japan (T.K.).
authors.forename: Yasutoshi
authors.initials: Y
authors.lastname: Shinoda
authors.affiliation: From the Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Japan (Y.K., A.N., K.M., A.K.T., K.A., Y. Shinoda, Y. Sekiguchi); Department of Heart Rhythm Management, Yokohama Rosai Hospital, Japan (K.K., Y.H., S.K.); Department of Cardiology, Ogaki Municipal Hospital, Japan (I.M.); Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Japan (T.O.); and Department of Cardiology and Hematology, Fukushima Medical University, Japan (T.K.).
authors.forename: Ahmed Karim
authors.initials: AK
authors.lastname: Talib
authors.affiliation: From the Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Japan (Y.K., A.N., K.M., A.K.T., K.A., Y. Shinoda, Y. Sekiguchi); Department of Heart Rhythm Management, Yokohama Rosai Hospital, Japan (K.K., Y.H., S.K.); Department of Cardiology, Ogaki Municipal Hospital, Japan (I.M.); Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Japan (T.O.); and Department of Cardiology and Hematology, Fukushima Medical University, Japan (T.K.).
authors.forename: Shinya
authors.initials: S
authors.lastname: Kowase
authors.affiliation: From the Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Japan (Y.K., A.N., K.M., A.K.T., K.A., Y. Shinoda, Y. Sekiguchi); Department of Heart Rhythm Management, Yokohama Rosai Hospital, Japan (K.K., Y.H., S.K.); Department of Cardiology, Ogaki Municipal Hospital, Japan (I.M.); Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Japan (T.O.); and Department of Cardiology and Hematology, Fukushima Medical University, Japan (T.K.).
authors.forename: Yukio
authors.initials: Y
authors.lastname: Sekiguchi
authors.affiliation: From the Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Japan (Y.K., A.N., K.M., A.K.T., K.A., Y. Shinoda, Y. Sekiguchi); Department of Heart Rhythm Management, Yokohama Rosai Hospital, Japan (K.K., Y.H., S.K.); Department of Cardiology, Ogaki Municipal Hospital, Japan (I.M.); Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Japan (T.O.); and Department of Cardiology and Hematology, Fukushima Medical University, Japan (T.K.).
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Aonuma
mesh_terms: D000328:Adult; D000368:Aged; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D002648:Child; D015331:Cohort Studies; D004562:Electrocardiography; D015716:Electrocardiography, Ambulatory / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010210:Papillary Muscles / Q000503:physiopathology; D011690:Purkinje Fibers / Q000503:physiopathology*; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome; D014700:Verapamil / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D014700:Verapamil
keywords: catheter ablation; fascicular ventricular tachycardia; papillary muscles