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Idiopathic Left Ventricular Tachycardia: Assessment and Treatment

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Cardiac Electrophysiology Review

Abstract

Idiopathic left ventricular tachycardia (VT) has been classified into three subgroups according to mechanism: verapamil-sensitive, adenosine-sensitive, and propranolol-sensitive types. VT can be categorized also into left fascicular VT and left outflow tract VT. Although the mechanism of fascicular VT is verapamil-sensitive reentry, the mechanism of left outflow tract VT is not homogeneous. Fascicular VT can be classified into three subtypes: (1) left posterior fascicular VT with a right bundle branch block (RBBB) and superior axis configuration (common form); (2) left anterior fascicular VT with RBBB and right-axis deviation configuration (uncommon form); and (3) upper septal fascicular VT with a narrow QRS and normal axis configuration (rare form). Posterior and anterior fascicular VT can be successfully ablated at the mid-septum guided by a diastolic Purkinje potential or at the VT exit site guided by a fused presystolic Purkinjepotential. Upper septal fascicular VT also can be ablated at the site indicated by a diastolic Purkinje potential. The mechanism of left ventricular outflow tract VT is most likely adenosine-sensitive triggered activity. This VT can be classified into three subtypes according to the location where catheter ablation is successful, i.e., (1) endocardial origin; (2) coronary cusp origin; and (3) epicardial origin. The R-wave duration and R/S-wave amplitude in V1/V2 can be used to differentiate coronary cusp VT from other types of outflow tract VT. Recognition of the characteristics of the various forms of this group of arrhythmias should facilitate appropriate diagnosis and therapy.

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References

  1. Lerman BB, Stein KM, Markowitz SM. Mechanism of idiopathic ventricular tachycardia. J Cardiovasc Electrophysiol 1997;8:571–583.

    Google Scholar 

  2. Okumura K, Tsuchiya T. Idiopathic left ventricular tachycardia: Clinical features, mechanism and management. Cardiac Electrophysiology Review 2002;6:61–67.

    Google Scholar 

  3. Rodriguez LM, Smeets JL, Timmermans C, Wellens HJ. Predictors for successful ablation of right-and leftsided idiopathic ventricular tachycardia. Am J Cardiol 1997;79:309–314.

    Google Scholar 

  4. Coggins DL, Lee RJ, Sweeney J, Chein WW, Van Hare G, Epstein L, Gonzalez R, Griffin JC, Lesh MD, Sheinman MM. Radiofrequency catheter ablation as a cure for idiopathic tachycardia of both left and right ventricular origin. J Am Coll Cardiol 1994;23:133–141.

    Google Scholar 

  5. Lerman BB, Stein K, Engelstein ED, Battleman DS, Lippman N, Bei D, Catanzaro D. Mechanism of repetitive monomorphic ventricular tachycardia. Circulation 1995;92:421–429.

    Google Scholar 

  6. Zipes DP, Foster PR, Troup PJ, Pedersen DH. Atrial induction of ventricular tachycardia: Reentry versus triggered automaticity. Am J Cardiol 1979;44:1–8.

    Google Scholar 

  7. Belhassen B, Rotmensch HH, Laniado S. Response of recurrent sustained ventricular tachycardia to verapamil. Br Heart J 1981;46:679–682.

    Google Scholar 

  8. Ohe T, Shimomura K, Aihara N, Kamakura S, Matsushita M, Sato I, Nakagawa H, Shimizu A. Idiopathic sustained left ventricular tachycardia: Clinical and electrophysiological characteristics. Circulation 1988;77:560–568.

    Google Scholar 

  9. Shimoike E, Ueda N, Maruyama T, Kaji Y. Radiofrequency catheter ablation of upper septal idiopathic left ventricular tachycardia exhibiting left bundle branch block morphology. J Cardiovasc Electrophysiol 2000;11:203–207.

    Google Scholar 

  10. Nakagawa H, Beckman KJ, McClelland JH, Wang X, Arruda M, Santoro I, Hazlitt HA, Abdalla I, Singh A, Gossinger H, Sweidan R, Hirao K, Widman L, Pitha JV, Lazzara R, Jackman WM. Radiofrequency catheter ablation of idiopathic left ventricular tachycardia guided by a Purkinje potential. Circulation 1993;88:2607–2617.

    Google Scholar 

  11. Tsuchiya T, Okumura K, Honda T, Iwasa A, Ashikaga K. Significance of late diastolic potential preceding Purkinje potential in verapamil-sensitive idiopathic left ventricular tachycardia. Circulation 1999;99:2408–2413.

    Google Scholar 

  12. Nogami A, Naito S, Tada H, Taniguchi K, Okamoto Y, Nishimura S, Yamauchi Y, Aonuma K, Goya M, Iesaka Y, Hiroe M. Demonstration of diastolic and presystolic Purkinje potential as critical potentials on a macroreentry circuit of verapamil-sensitive idiopathic left ventricular tachycardia. J Am Coll Cardiol 2000;36:811–823.

    Google Scholar 

  13. Gallagher JJ, Selle JG, Svenson RH, Fedor JM, Zimmern SH, Sealy WC, Robicsek FR. Surgical treatment of arrhythmias. Am J Cardiol 1988;61:27A–44A.

    Google Scholar 

  14. Suwa M, Yoneda Y, Nagao H, Sakai Y, Nakayama Y, Hirota Y, Kawamura K, Iwa T. Surgical correction of idiopathic paroxysmal ventricular tachycardia possibly related to left ventricular false tendon. Am J Cardiol 1989;64:1217–1220.

    Google Scholar 

  15. Thakur RK, Klein GJ, Sivaram CA, Zardini M, Schleinkofer DE, Nakagawa H, Yee R, Jackman WM. Anatomic substrate for idiopathic left ventricular tachycardia. Circulation 1996;93:497–501.

    Google Scholar 

  16. Maruyama M, Terada T, Miyamoto S, Ino T. Demonstration of the reentrant circuit of verapamil-sensitive idiopathic left ventricular tachycardia: Direct evidence for macroreentry as the underlying mechanism. J Cardiovasc Electrophysiol 2001;12:968–972.

    Google Scholar 

  17. Lin FC, Wen MS, Wang CC, Yeh SJ, Wu D. Left ventricular fibromuscular band is not a specific substrate for idiopathic left ventricular tachycardia. Circulation 1996;93:525–527.

    Google Scholar 

  18. Nogami A, Naito S, Tada H, Oshima S, Taniguchi K, Aonuma K, Iesaka Y. Verapamil-sensitive left anterior fascicular ventricular tachycardia: Results of radiofrequency ablation in six patients. J Cardiovasc Electrophysiol 1998;9:1269–1278.

    Google Scholar 

  19. Kobayashi Y, Kikushima S, Tanno K, Baba T, Katagiri T. Sustained left ventricular tachycardia terminated by dipyridamole: Camp-mediated triggered activity as a possible mechanism. PACE 1944;17:377–385.

    Google Scholar 

  20. Lerman BB. Response of nonreentrant catecholamine-mediated ventricular tachycardia to endogenous adenosine and acetylcholine: Evidence for myocardial receptor-mediated effects. Circulation 1993;87:382–390.

    Google Scholar 

  21. Callans DJ, Menz V, Schwartzman D, Gottlieb CD, Marchkinski FE. Repetitive monomorphic ventricular tachycardia from left ventricular outflow tract: Electrocardiographic patterns consistent with a left ventricular site of origin. J Am Coll Cardiol 1997;29:1023–1027.

    Google Scholar 

  22. Yeh SJ, Wen MS, Wang CC, Lin FC, Wu D. Adenosinesensitive ventricular tachycardia from the anterobasal left ventricle. J Am Coll Cardiol 1997;30:1339–1345.

    Google Scholar 

  23. Shimoike E, Ohnishi Y, Ueda N, Maruyama T, Kaji Y. Radiofrequency catheter ablation of the left ventricular outflow tract tachycardia from a coronary cusp: A new approach to the tachycardia focus. J Cardiovasc Electrophysiol 1999;10:1005–1009.

    Google Scholar 

  24. Sadanaga T, Saeki K, Yoshimoto T, Funatsu Y, Miyazaki T. Repetitive monomorphic ventricular tachycardia of the left coronary cusp origin. PACE 1999;22:1553–1556.

    Google Scholar 

  25. Tada H, Nogami A, Naito S, Fukazawa H, Horie Y, Kubota S, Okamoto Y, Hoshizaki H, Oshima S, Taniguchi K. Left ventricular epicardial outflow tract tachycardia: New distinct subgroup of outflow tract tachycardia. Jpn Circ J 2001;65:723–730.

    Google Scholar 

  26. Da Paola AV, Melo WDS, Tavora MZP, Martinez EE. Angiographic and electrophysiological substrates for ventricular tachycardia mapping through the coronary veins. Heart 1998;79:59–63.

    Google Scholar 

  27. Tomassoni G, Stanton M, Richey M, Leonelli FM, Beheiry S, Natale A. Epicardial mapping and radiofrequency catheter ablation of ischemic ventricular tachycardia using a three-dimensional nonfluoroscopic mapping system. J Cardiovasc Electrophysiolo 1999;10:1643–1648.

    Google Scholar 

  28. Hachiya H, Aonuma K, Yamauchi Y, Harada T, Igawa M, Nogami A, Iesaka Y, Hiroe M, Marumo F. Electrocardiographic characteristics of left ventricular outflow tachycardia. PACE 2000;23[Pt. II]:1930–1934.

    Google Scholar 

  29. Kanagaratnam L, Tomassoni G, Schweikert R, Pavia S, Bash D, Beheiry S, Niebauer M, Saliba W, Chung M, Tchou P, Natale A. Ventricular tachycardia arising from the aortic sinus of Valsalva: An under-recognized variant of left outflow ventricular tachycardia. J Am Coll Cardiol 2001;37:1408–1414.

    Google Scholar 

  30. Ouyang F, Fotuhi P, Yen S, Hebe J, Volkmer M, Goya M, Burns M, Antz M, Ernst S, Cappato R, Kuck KH. Repetitive monomorphic ventricular tachycardia originating from the aortic sinus cusp: Electrocardiographic characterization for guiding catheter ablation. J Am Coll Cardiol 2002; 39:500–508.

    Google Scholar 

  31. Hachiya H, Aonuma K, Yamauchi Y, Igawa M, Nogami A, Iesaka Y. How to diagnose, locate, and ablate coronary cusp ventricular tachycardia. J Cardiovasc Electrophysiol 2002;13:551–556.

    Google Scholar 

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  1. Clinical Electrophysiology Laboratory and Pacemaker Service, Yokohama Rosai Hospital, Yokohama, Kanagawa, Japan

    Akihiko Nogami

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  1. Akihiko Nogami
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Nogami, A. Idiopathic Left Ventricular Tachycardia: Assessment and Treatment. Card Electrophysiol Rev 6, 448–457 (2002). https://doi.org/10.1023/A:1021100828459

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