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(Circulation. 1999;99:2408-2413.)
© 1999 American Heart Association, Inc.

Clinical Investigation and Reports

Significance of Late Diastolic Potential Preceding Purkinje Potential in Verapamil-Sensitive Idiopathic Left Ventricular Tachycardia

Takeshi Tsuchiya, MD; Ken Okumura, MD; Toshihiro Honda, MD; Takashi Honda, MD; Atsushi Iwasa, MD; Hirofumi Yasue, MD; Toshifumi Tabuchi, MD

From the Cardiovascular Center (T. Tsuchiya, Toshihiro Honda, Takashi Honda), Saiseikai Kumamoto Hospital, Kumamoto, the Second Department of Internal Medicine (K.O., A.I.), Hirosaki University School of Medicine, Hirosaki, and the Division of Cardiology (H.Y., T. Tabuchi), Kumamoto University School of Medicine, Kumamoto, Japan.

Correspondence to Ken Okumura, MD, Second Department of Internal Medicine, Hirosaki University School of Medicine, Zaifu-cho 5, Hirosaki, 036-8562 Japan. E-mail okumura{at}cc.hirosaki-u.ac.jp

Background—Verapamil-sensitive idiopathic left ventricular tachycardia (VT) is due to reentry with an excitable gap. A late diastolic potential (LDP) is recorded during endocardial mapping of this VT, but its relation to the reentry circuit and significance in radiofrequency (RF) ablation remain to be elucidated.

Methods and Results—Sixteen consecutive patients with this specific VT were studied (12 men and 4 women; mean age, 32 years). In all patients, sustained VT was induced and during left ventricular endocardial mapping, LDP preceding Purkinje potential (PP) was recorded at the basal (11 patients), middle (3 patients), or apical septum (2 patients). The area with LDP recording was confined to a small region (0.5 to 1.0 cm²) in each patient and was included in the area where PP was recorded (2 to 3 cm²). The relative activation times of LDP, PP, and local ventricular potential (V) at the LDP recording site to the onset of QRS complex were -50.4±18.9, -15.2±9.6, and 3.0±13.3 ms, respectively. The earliest ventricular activation site during VT was identified at the posteroapical septum and was more apical in the septum than the region with LDP in every patient. In 9 patients, VT entrainment was done by pacing from the right ventricular outflow tract while recording LDP. During entrainment, LDP was orthodromically captured, and as the pacing rate was increased, the LDP-to-PP interval was prolonged, whereas stimulus-to-LDP and PP-to-V interval were constant. In 3 patients, the pressure applied to the catheter tip at the LDP region resulted in conduction block between LDP and PP and in VT termination. RF energy application at the LDP recording site successfully eliminated VT.

Conclusions—LDP was suggested to represent the excitation at the entrance to the specialized area with a conduction delay in response to the increase in the rate within the critical slow conduction zone participating in the reentry circuit of this VT. LDP can be a useful marker for successful RF ablation for this VT.

Key Words: tachycardia • potentials • catheter ablation

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