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European Journal of Medical Research

, 20:77

First Online: 17 September 2015Received: 14 December 2014Accepted: 24 July 2015DOI: 10.1186-s40001-015-0156-y

Cite this article as: Puie, P., Cismaru, G., Muresan, L. et al. Eur J Med Res 2015 20: 77. doi:10.1186-s40001-015-0156-y

Abstract

Left ventricular posterior fascicular tachycardia LVPFT is an idiopathic form of VT characterized by right bundle branch block morphology and left axis deviation. The mechanism of LPFVT is thought to be localized reentry close to the posterior fascicle. We present the case of a 24-year-old medical student who was admitted to the emergency department complaining of palpitations. The ECG showed an aspect suggestive of LVPFT. Vagal maneuvers, adenosine and i.v. Metoprolol were ineffective in terminating the arrhythmia. Conversion to sinus rhythm was obtained 10 h later, with i.v Amiodarone. The ECG in sinus rhythm showed left posterior fascicular block. Because antiarrhythmic drugs were not desired by the patient, VT ablation was proposed. The electrophysiological study identified the mechanism of arrhythmia to be reentry using the slowly conducting verapamil-sensitive fibers as the antegrade limb and the posterior fascicle as the retrograde limb. Radiofrequency applications near the posterior fascicle, in the lower half of the interventricular septum, at the junction of the two proximal thirds with the distal third interrupted the tachycardia and made it non-inducible at programmed stimulation. The case is unusual as the patient had a left posterior fascicular block during sinus rhythm before ablation. This demonstrates that the reentry circuit of VT does not need antegrade conduction through the posterior fascicle for perpetuation.

KeywordsVentricular tachycardia Left posterior fascicle Ablation Mapping Amiodarone AbbreviationsVTventricular tachycardia

LPFVTleft posterior fascicular ventricular tachycardia

i.v.intravenously

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Autor: Paul Puie - Gabriel Cismaru - Lucian Muresan - Radu Rosu - Mihai Puiu - Marius Andronache - Gabriel Gusetu - Roxana Matuz

Fuente: https://link.springer.com/







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