Radiofrequency catheter ablation of Purkinje system involved ventricular tachycardia after myocardial infarction
- Author:
- No author available
- Journal Title:
- Chinese Journal of Cardiac Arrhythmias
- Issue:
- 4
- DOI:
- 10.3760/cma.j.issn.1007-6638.2012.04.003
- Key Word:
- 室性心动过速;浦肯野纤维;心肌梗死;导管消融;Ventricular tachycardia;Purkinje system;Myocardial infarction;Catheter ablation
Abstract： Objective To investigate the mechanism and radiofrequency catheter ablation of ventricular tachycardia (VT) arising from the left posterior Purkinje fibers in patients with a prior myocardial infarction (MI).Methods Three patients were all male s,and aged 55 to 75 years old,with recurrent episodes of VT after anterior MI [ left ventricular ejection fraction (LVEF) 0.44 ～ 0.61] despite antiarrhythmic drugs and/or revascularization therapy.The VT or premature ventricular contractions (PVC) presented right bundle branch block (RBBB) with left axis or right axis deviation.Carto electroanatomic mapping system and saline irrigated radiofrequency catheter were used for mapping and ablating of VT/PVC.Results Clinical sustained VT was reproducibly induced by programmed stimulation in 2 patients,and spontaneous clinical non-sustained VT/PVC were observed in 1 patient.Purkinje potentials (PP) or diastolic potentials (DP) were sequentially observed along the left ventricular posterior septum adjacent to the low voltage area during the VT/PVC in all the 3 patients.The typical macro-reentrant VT around the MI scar could not be mapped in anyone of the 3 patients.Radiofrequency energy delivered at the site exhibiting a PP/DP-QRS interval of-20 to -70 ms successfully eliminated the VT/PVC.Conclusion Purkinje system involved monomorphic VT after MI,which is analogous to idiopathic left VT,can develop in the acute or chronic phase of MI.Radiofrequency catheter ablation can effectively eliminate this VT without affecting left ventricular conduction.
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