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Verapamil-sensitive left anterior fascicular ventricular tachycardia associated with a healed myocardial infarction: changes in the delayed Purkinje potential during sinus rhythm

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Abstract

Uncommon association of left anterior fascicular ventricular tachycardia (VT) with a healed myocardial infarction (MI) is described. A 55-year-old man with a history of anteroseptal MI had verapamil-sensitive VT. The VT exhibited a right bundle branch block configuration and right-axis deviation. The VT exit was located at the left ventricular anterolateral wall. At the mid-anterior left ventricular septum, delayed Purkinje potentials were seen during sinus rhythm, and the optimal pace map was obtained with pace delay. During the VT, diastolic and systolic Purkinje potentials were simultaneously recorded at the same site. Ablation targeting the delayed potentials during sinus rhythm prolonged the time between QRS onset and the delayed potentials, and the VT no longer became inducible when the delayed potentials were completely eliminated. Left anterior fascicular VT develops in post-MI patients; ischemia-injured His-Purkinje system may be involved in the mechanism of the VT.

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Abbreviations

HPS:

His-Purkinje system

MI:

myocardial infarction

RBBB:

right bundle branch block

RF:

radiofrequency

VT:

ventricular tachycardia

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Authors and Affiliations

  1. Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, 503-0864, Japan

    Itsuro Morishima, Hideyuki Tsuboi & Takahito Sone

  2. Cardiology Division, Yokohama Rosai Hospital, Yokohama, Japan

    Akihiko Nogami

Authors
  1. Itsuro Morishima
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  2. Akihiko Nogami
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  3. Hideyuki Tsuboi
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  4. Takahito Sone
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Correspondence to Itsuro Morishima.

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Morishima, I., Nogami, A., Tsuboi, H. et al. Verapamil-sensitive left anterior fascicular ventricular tachycardia associated with a healed myocardial infarction: changes in the delayed Purkinje potential during sinus rhythm. J Interv Card Electrophysiol 22, 233–237 (2008). https://doi.org/10.1007/s10840-008-9268-4

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