Comercialización Petrolera

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Cure of Interfascicular Reentrant Ventricular Tachycardia by Ablation of tbe Anterior Fascicle of tbe Left Bundle Brancb HARRY J.G.M. CRIJNS, M.D., JOEP L.R.M. SMEETS, M,D., LUZ MARIA RODRIGUEZ, M.D., ALBERT MEIJER, M.D,, and HEIN J.J. WELLENS, M,D. From the Department of Cardiology, University Hospital Maastricht, Maastricht, The Netherlands

Ablation of Interfascicular Reentrant Tachycardia. Introduction: Fascicular reentrant ventricular tachycardia (VT) using the anterior fascicle of the left bundle anterogradely is rare and may produce identical QRS morphology during sinus rhythm and VT. Catheter ablation of this type of VT has not been described in detail. Methods and Results: In a postinfaret patient with dilated left ventricle and recurrent VT (showing a QRS configuration of right bundle branch, left posterior fascicular block), endocardial recordings from the His-Purkinje system showed that VT was due to interfascicular reentry. Induction of VT occurred after progressive retrograde conduction delay on increasing the prematurity of the extrastimulus. Anterograde conduction occurred exclusively over the left anterior fascicle, which caused identical QRS morphology during sinus rhythm and VT. During VT, the left posterior fascicle was used retrogradely. The usual target for bundle branch reentry ablation, the right bundle, did not participate in the reentrant circuit. While performing left ventricular endocardial mapping, VT was interrupted when positioning the caiheter on the left anterior fascicle, and "reversed" nonsustained bundle branch reentry occurred with anterograde conduction over the posterior fascicle and retrograde conduction over the anterior fascicle. Ablation of conduction in tbe anterior fascicle led to cure of the VT. Conclusion: Interfascicular reentrant VT witb right bundle branch block, right-axis QRS configuration can be cured by catheter ablation of anterior fascicle conduction. (J Cardiovasc Electrophysiol. Vol. 6. pp. 486-492, June 1995)

interfascicular reentry, bundle branch reentry, ventricular tachycardia, catheter ablation, anterior fascicle Introduction Bundle branch reentry was suggested as a mechanism for ventricular tachycardia (VT) more than 20 years ago.' Bundle branch reentrant VT occurs most frequently in the setting of structural heart disease, particularly in dilated he