Talib Ahmed Karim, Nogami Akihiko, Morishima Itsuro, Oginosawa Yasushi, Kurosaki Kenji, Kowase Shinya, Komatsu Yuki, Kuroki Kenji, Igarashi Miyako, Sekiguchi Yukio, Aonuma Kazutaka
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.).
Circ Arrhythm Electrophysiol. 2016 Oct;9(10). doi: 10.1161/CIRCEP.116.004177.
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.
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.
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.
特发性浦肯野纤维相关室性心动过速（VT）最常见的形式是折返型。我们描述了局灶性非折返性束支性心动过速的临床和电生理特征。
在530例因消融而转诊的特发性VT患者中，我们识别出15例（2.8%）患有非折返性束支性心动过速（11例男性，年龄45±21岁）。窦性心律心电图显示传导间期正常，希氏束-心室间期为41±4毫秒。所有患者均有单形性VT（周长：337±88毫秒），QRS波相对较窄（123±12毫秒），且在初次就诊时对维拉帕米无反应。11例患者（73%）的VT表现为右束支传导阻滞/上轴形态，3例（20%）为下轴形态。1例患者（7%）的VT表现为左束支传导阻滞/上轴形态。在消融过程中，3例患者（20%）出现自发性VT，9例（60%）诱发了不可拖带的VT或相同的室性早搏。在VT/室性早搏期间记录到高频收缩前期浦肯野电位，早于QRS波25±16毫秒。4例患者（27%）观察到VT复发，其中3例在首次手术期间接受了起搏标测引导下的消融。在88±8个月的随访期间，通过激动标测引导进行的第二次消融消除了VT。
在因消融而转诊的特发性VT病例中，2.8%为局灶性非折返性束支性心动过速，其具有独特的临床特征，通常起源于左后分支，较少起源于左前分支和右心室浦肯野网络。导管消融是有效的，而起搏标测引导的方法效果较差。
