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Europace Advance Access originally published online on August 6, 2009
Europace 2009 11(9):1208-1213; doi:10.1093/europace/eup206
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org.

Electrophysiology and Ablation

Characteristics of bundle branch reentrant ventricular tachycardia with a right bundle branch block configuration: feasibility of atrial pacing

Yuka Mizusawa1,*, Harumizu Sakurada1, Mitsuhiro Nishizaki2, Akiko Ueda-Tatsumoto1, Seiji Fukamizu1 and Masayasu Hiraoka3,4

1 Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya-ku, Tokyo 150-0013, Japan; 2 Department of Cardiology, Yokohama Minami Kyosai Hospital, 1-21-1 Mutsuura-higashi, Kanazawaku, Yokohama, Kanagawa 236-0037, Japan; 3 Tokyo Medical and Dental University, Tokyo, Japan; 4 Labor Insurance Appeal Committee, Ministry of Health, Labor and Welfare of Japan, 1-5-32, Shibakouen, Minato-ku, Tokyo 105-0011, Japan

Aims: We assessed the inducibility of bundle branch reentrant ventricular tachycardia (BBR-VT) with a right bundle branch block (RBBB) configuration in patients with BBR-VT.

Methods and results: Eight consecutive patients (5 men, 45 ± 18 years old) with inducible BBR-VT were included. We evaluated the clinical and electrophysiological characteristics in these patients to explore the inducible factors of BBR-VT with an RBBB configuration. Six of eight patients had inducible BBR-VT with an RBBB configuration, including four patients with a clinical VT with the same QRS morphology. All patients exhibited an LBBB or RBBB type intraventricular conduction disturbance during sinus rhythm. The mean HV interval at baseline was 79 ± 18 ms. The reproducibility of the BBR-VT with an RBBB pattern was achieved by incremental atrial pacing during an isoproterenol infusion in 4/6 patients (67%) and by programmed ventricular stimulation in the other two. After a right bundle ablation, the BBR-VT was no longer inducible in any of the cases.

Conclusion: Our results indicate that it is not rare to induce BBR-VT with an RBBB configuration. For the induction of an RBBB type BBR-VT, incremental atrial pacing may play a significant role in addition to ventricular pacing.

Key Words: Bundle branch reentrant ventricular tachycardia, Right bundle branch block configuration, Atrial pacing, Isoproterenol, Programmed ventricular stimulation

* Corresponding author. Tel: +81 3 3444 1181, Fax: +81 3 3444 3196, Email: yuka_m12{at}msn.com

Manuscript submitted 28 April 2009. Accepted after revision 3 July 2009.


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