Europace Advance Access published online on January 28, 2008
Europace, doi:10.1093/europace/eun004
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His-Purkinje system re-entry in patients with clustering ventricular tachycardia episodes
Department of Cardiology, Swiss Cardiovascular Center Bern, University Hospital, CH-3010 Bern, Switzerland
Aims: Multiple arrhythmia re-inductions were recently shown in His-Purkinje system (HPS) ventricular tachycardia (VT). We hypothesized that HPS VT was a frequent mechanism of repetitive or incessant VT and assessed diagnostic criteria to select patients likely to have HPS VT.
Methods and results: Consecutive patients with clustering VT episodes (>3 sustained monomorphic VT within 2 weeks) were included in the analysis. HPS VT was considered plausible in patients with (i) impaired left ventricular function associated with dilated cardiomyopathy or valvular heart disease; or (ii) ECG during VT similar to sinus rhythm QRS or to bundle-branch block QRS. HPS VT was plausible in 12 of 48 patients and HPS VT was demonstrated in 6 of 12 patients (50%, or 13% of the whole study group). Median VT cycle length was 318 ms (250–550). Catheter ablation was successful in all six patients.
Conclusion: His-Purkinje system VT is found in a significant number of patients with repetitive or incessant VT episodes, and in a large proportion of patients with predefined clinical or electrocardiographic characteristics. Since it is easily amenable to catheter ablation, our data support the screening of all patients with repetitive VT in this regard and an invasive approach in a selected group of patients.
Key Words: Bundle-branch re-entry, Ventricular tachycardia storm, Catheter ablation
* Corresponding author. Tel: +41 31 632 21 11; fax: +41 31 632 14 14. E-mail address: etienne.delacretaz{at}insel.ch
Manuscript submitted 23 October 2007. Accepted after revision 28 December 2007.