This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ouyang, F. Articles by Kuck, K.-H. Search for Related Content PubMed PubMed Citation Articles by Ouyang, F. Articles by Kuck, K.-H. Related Collections Electrophysiology Ablation/ICD/surgery Arrhythmias, clinical electrophysiology, drugs

(Circulation. 2002;105:462.)
© 2002 American Heart Association, Inc.

Clinical Investigation and Report

Electroanatomic Substrate of Idiopathic Left Ventricular Tachycardia

Unidirectional Block and Macroreentry Within the Purkinje Network

Feifan Ouyang, MD; Riccardo Cappato, MD; Sabine Ernst, MD; Masahiko Goya, MD; Marius Volkmer, MD; Joachim Hebe, MD; Matthias Antz, MD; Thomas Vogtmann, MD; Anselm Schaumann, MD; Parwis Fotuhi, MD; Martin Hoffmann-Riem, MD; Karl-Heinz Kuck, MD

From Zweite Medizinische Abteilung, Allgemeines Krankenhaus St Georg, Hamburg, Germany and Department of Cardiology (R.C.), San Donato Hospital, Milan, Italy.

Correspondence to Feifan Ouyang, MD, II Med Abteilung, Allgemeines Krankenhaus St Georg, Lohmühlenstr 5, 20099 Hamburg, Germany. E-mail Ouyangfeifan{at}aol.com

Background— An abnormal potential (retroPP) from the left posterior Purkinje network has been demonstrated during sinus rhythm (SR) in some patients with idiopathic left ventricular tachycardia (ILVT). We hypothesized that this potential can specifically be identified and be a critical substrate for ILVT.

Methods and Results— In 9 patients with ILVT and 6 control patients who underwent mapping of the left ventricle during SR using 3-dimensional electroanatomic mapping, an area with retroPP was found within the posterior Purkinje fiber network only in patients with ILVT. The earliest and latest retroPP was 185.4±57.4 and 465.2±37.3 ms after Purkinje potential; in the other patient with ILVT, an entire left ventricle mapping demonstrated a slow conduction area and passive retrograde activation along the posterior fascicle during ILVT. ILVT was noninducible in 3 patients after SR mapping. Diastolic potentials critical for ILVT during ILVT coincided with the earliest retroPP during SR in 7 patients. Mechanical termination of ILVT occurred in 5 patients. A single radiofrequency pulse was applied at the site with mechanical translation in 5 patients and the site with diastolic potential in 2 patients, and 3 radiofrequency pulses were delivered to the site with the earliest retroPP in the other 3 patients without inducible ILVT after SR mapping. No ILVT was inducible during control stimulation, and none recurred during follow-up of 9.1±5.1 months.

Conclusion— In patients with ILVT, abnormal retroPP within the posterior Purkinje fiber network is a common finding. The earliest retroPP critical for ILVT substrate can be used for guiding successful ablation.

Key Words: catheter ablation • electrophysiology • mapping • tachycardia

This article has been cited by other articles:

				E. M. Aliot, W. G. Stevenson, J. M. Almendral-Garrote, F. Bogun, C. H. Calkins, E. Delacretaz, P. D. Bella, G. Hindricks, P. Jais, M. E. Josephson, et al. EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias: Developed in a partnership with the European Heart Rhythm Association (EHRA), a Registered Branch of the European Society of Cardiology (ESC), and the Heart Rhythm Society (HRS); in collaboration with the American College of Cardiology (ACC) and the American Heart Association (AHA) Europace, June 1, 2009; 11(6): 771 - 817. [Full Text] [PDF]

				M. Hirose, B. D. Stuyvers, W. Dun, H. E.D.J. ter Keurs, and P. A. Boyden Function of Ca2+ Release Channels in Purkinje Cells That Survive in the Infarcted Canine Heart: A Mechanism for Triggered Purkinje Ectopy Circ Arrhythm Electrophysiol, December 1, 2008; 1(5): 387 - 395. [Abstract] [Full Text] [PDF]

				K. H.W.J. Ten Tusscher, R. Hren, and A. V. Panfilov Organization of Ventricular Fibrillation in the Human Heart Circ. Res., June 22, 2007; 100(12): e87 - e101. [Abstract] [Full Text] [PDF]

				W. G. Stevenson and K. Soejima Catheter Ablation for Ventricular Tachycardia Circulation, May 29, 2007; 115(21): 2750 - 2760. [Full Text] [PDF]

				D. V. Daniels, Y.-Y. Lu, J. B. Morton, P. A. Santucci, J. G. Akar, A. Green, and D. J. Wilber Idiopathic Epicardial Left Ventricular Tachycardia Originating Remote From the Sinus of Valsalva: Electrophysiological Characteristics, Catheter Ablation, and Identification From the 12-Lead Electrocardiogram Circulation, April 4, 2006; 113(13): 1659 - 1666. [Abstract] [Full Text] [PDF]

				A. Berruezo, L. Cano, L. Mont, and J. Brugada Epicardial ablation of syncopal ventricular tachycardia. Utility of the electrocardiogram. Europace, January 1, 2006; 8(5): 338 - 340. [Abstract] [Full Text] [PDF]

				M. Chen, B. Yang, J. Zou, Q. Shan, C. Chen, D. Xu, and K. Cao Non-contact mapping and linear ablation of the left posterior fascicle during sinus rhythm in the treatment of idiopathic left ventricular tachycardia Europace, January 1, 2005; 7(2): 138 - 144. [Abstract] [Full Text] [PDF]

				D. G Katritsis and A.J. Camm Nonsustained ventricular tachycardia: where do we stand? Eur. Heart J., July 1, 2004; 25(13): 1093 - 1099. [Abstract] [Full Text] [PDF]

				A. Berruezo, L. Mont, S. Nava, E. Chueca, E. Bartholomay, and J. Brugada Electrocardiographic Recognition of the Epicardial Origin of Ventricular Tachycardias Circulation, April 20, 2004; 109(15): 1842 - 1847. [Abstract] [Full Text] [PDF]

				F. Ouyang, M. Antz, F. T. Deger, D. Bansch, A. Schaumann, S. Ernst, and K.-H. Kuck An Underrecognized Subepicardial Reentrant Ventricular Tachycardia Attributable to Left Ventricular Aneurysm in Patients With Normal Coronary Arteriograms Circulation, June 3, 2003; 107(21): 2702 - 2709. [Abstract] [Full Text] [PDF]