束
医学
右束支阻滞
烧蚀
心脏病学
心动过速
导管消融
内科学
维拉帕米
QRS波群
心脏传导系统
室性心动过速
有效耐火期
心电图
解剖
耐火期
钙
作者
Avishag Laish-Farkash,Avi Sabbag,Michael Glikson,Aharon Glick,Vladimir Khalameizer,Amos Katz,Yoav Michowitz
出处
期刊:PubMed
日期:2018-01-01
卷期号:20 (1): 43-50
被引量:1
摘要
Multiform fascicular tachycardia (FT) was recently described as a ventricular tachycardia (VT) that has a reentrant mechanism using multiple fascicular branches and produces alternate fascicular VT forms. Ablating the respective fascicle may cause a change in the reentrant circuit resulting in a change in morphology. Ablation of the septal fascicle is crucial for successful treatment.To describe four cases of FT in which ablation induced a change in QRS morphologies and aggravated clinical course.Four out of 57 consecutive FT cases at three institutions were retrospectively analyzed and found to involve multiform FT. These cases underwent electrophysiological study, fascicular potential mapping, and electroanatomical mapping. All patients initially had FT with right bundle branch block (RBBB) and superior axis morphology.Radiofrequency catheter ablation (RFCA) targeting the distal left posterior fascicle (LPF) resulted in a second VT with an RBBB-inferior axis morphology that sometimes became faster and/or incessant and/or verapamil-refractory in characteristics. RFCA in the upper septum abolished the second VT with no complications and uneventful long-term follow-up.The change in FT morphology during ablation may be associated with a change in clinical course when shifting from one route to another and may aggravate symptoms. Targeting of the proximal conduction system (such as bifurcation, LPF, left anterior fascicle, high septal/auxiliary pathway) may serve to solve this problem.
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