Verapamil-Sensitive Upper Septal Idiopathic Left Ventricular Tachycardia Prevalence, Mechanism, and Electrophysiological Characteristics

Ahmed Karim Talib, Akihiko Nogami, Suguru Nishiuchi, Shinya Kowase, Kenji Kurosaki, Yumie Matsui, Satoshi Kawada, Atsuyuki Watanabe, Masatsugu Nozoe, Kikuya Uno, Atsuhiko Yagishita, Yasuteru Yamauchi, Yoshihide Takahashi, Taishi Kuwahara, Atsushi Takahashi, Koji Kumagai, Shigeto Naito, Tetsuya Asakawa, Yukio Sekiguchi, Kazutaka Aonuma

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Objectives This study sought to demonstrate the prevalence, mechanism, and electrocardiographic and electrophysiological characteristics of upper septal idiopathic left fascicular ventricular tachycardia (US-ILVT). Background ILVT is classified into left anterior and posterior types with no clear data about US-ILVT. Methods Among 193 ILVT patients, we identified 12 patients (6.2%; age 41 ± 22 years, 7 men) with US-ILVT. Results Of 12 patients with US-ILVT, 6 patients (50%) had previous history of radiofrequency catheter ablation for common ILVT. Sustained VT (cycle length: 349 ± 53 ms) was seen in all patients with a QRS interval slightly wider (104 ± 18 ms) than that during sinus rhythm (90 ± 19 ms). The VT exhibited an identical QRS configuration as sinus rhythm in 6 (50%) and incomplete right bundle branch block configuration in another 6. His-ventricular interval during VT was always shorter than that during sinus rhythm (27 ± 5 ms vs. 47 ± 10 ms). Purkinje potentials were activated in a reverse direction to that of common ILVT; namely, the diastolic potential (P1) was activated retrogradely but the pre-systolic potential (P2) was activated antegradely. At the left upper-middle ventricular septum, P1 potential was recorded during VT, preceding the QRS by 54 ± 20 ms. Radiofrequency catheter ablation at that site eliminated the VT with no recurrence during a 58 ± 35 months of follow-up. Conclusions US-ILVT is an identifiable VT that shares common criteria with ILVT and has a narrow QRS interval. Some US-ILVT cases appeared after common ILVT ablation. It is a reverse type of common ILVT (orthodromic form) with baseline morphological abnormalities that might provide a potential substrate for such VT.

Original languageEnglish
Pages (from-to)369-380
Number of pages12
JournalJACC: Clinical Electrophysiology
Volume1
Issue number5
DOIs
Publication statusPublished - Oct 1 2015
Externally publishedYes

Fingerprint

Ventricular Tachycardia
Verapamil
Catheter Ablation
Ventricular Septum
Bundle-Branch Block
Recurrence

Keywords

  • ablation
  • left fascicle
  • left upper septum
  • ventricular tachycardia
  • verapamil

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Verapamil-Sensitive Upper Septal Idiopathic Left Ventricular Tachycardia Prevalence, Mechanism, and Electrophysiological Characteristics. / Talib, Ahmed Karim; Nogami, Akihiko; Nishiuchi, Suguru; Kowase, Shinya; Kurosaki, Kenji; Matsui, Yumie; Kawada, Satoshi; Watanabe, Atsuyuki; Nozoe, Masatsugu; Uno, Kikuya; Yagishita, Atsuhiko; Yamauchi, Yasuteru; Takahashi, Yoshihide; Kuwahara, Taishi; Takahashi, Atsushi; Kumagai, Koji; Naito, Shigeto; Asakawa, Tetsuya; Sekiguchi, Yukio; Aonuma, Kazutaka.

In: JACC: Clinical Electrophysiology, Vol. 1, No. 5, 01.10.2015, p. 369-380.

Research output: Contribution to journalArticle

Talib, AK, Nogami, A, Nishiuchi, S, Kowase, S, Kurosaki, K, Matsui, Y, Kawada, S, Watanabe, A, Nozoe, M, Uno, K, Yagishita, A, Yamauchi, Y, Takahashi, Y, Kuwahara, T, Takahashi, A, Kumagai, K, Naito, S, Asakawa, T, Sekiguchi, Y & Aonuma, K 2015, 'Verapamil-Sensitive Upper Septal Idiopathic Left Ventricular Tachycardia Prevalence, Mechanism, and Electrophysiological Characteristics', JACC: Clinical Electrophysiology, vol. 1, no. 5, pp. 369-380. https://doi.org/10.1016/j.jacep.2015.05.011
Talib, Ahmed Karim ; Nogami, Akihiko ; Nishiuchi, Suguru ; Kowase, Shinya ; Kurosaki, Kenji ; Matsui, Yumie ; Kawada, Satoshi ; Watanabe, Atsuyuki ; Nozoe, Masatsugu ; Uno, Kikuya ; Yagishita, Atsuhiko ; Yamauchi, Yasuteru ; Takahashi, Yoshihide ; Kuwahara, Taishi ; Takahashi, Atsushi ; Kumagai, Koji ; Naito, Shigeto ; Asakawa, Tetsuya ; Sekiguchi, Yukio ; Aonuma, Kazutaka. / Verapamil-Sensitive Upper Septal Idiopathic Left Ventricular Tachycardia Prevalence, Mechanism, and Electrophysiological Characteristics. In: JACC: Clinical Electrophysiology. 2015 ; Vol. 1, No. 5. pp. 369-380.
@article{0e25d7d55c134b74b97b1187fcf7394e,
title = "Verapamil-Sensitive Upper Septal Idiopathic Left Ventricular Tachycardia Prevalence, Mechanism, and Electrophysiological Characteristics",
abstract = "Objectives This study sought to demonstrate the prevalence, mechanism, and electrocardiographic and electrophysiological characteristics of upper septal idiopathic left fascicular ventricular tachycardia (US-ILVT). Background ILVT is classified into left anterior and posterior types with no clear data about US-ILVT. Methods Among 193 ILVT patients, we identified 12 patients (6.2{\%}; age 41 ± 22 years, 7 men) with US-ILVT. Results Of 12 patients with US-ILVT, 6 patients (50{\%}) had previous history of radiofrequency catheter ablation for common ILVT. Sustained VT (cycle length: 349 ± 53 ms) was seen in all patients with a QRS interval slightly wider (104 ± 18 ms) than that during sinus rhythm (90 ± 19 ms). The VT exhibited an identical QRS configuration as sinus rhythm in 6 (50{\%}) and incomplete right bundle branch block configuration in another 6. His-ventricular interval during VT was always shorter than that during sinus rhythm (27 ± 5 ms vs. 47 ± 10 ms). Purkinje potentials were activated in a reverse direction to that of common ILVT; namely, the diastolic potential (P1) was activated retrogradely but the pre-systolic potential (P2) was activated antegradely. At the left upper-middle ventricular septum, P1 potential was recorded during VT, preceding the QRS by 54 ± 20 ms. Radiofrequency catheter ablation at that site eliminated the VT with no recurrence during a 58 ± 35 months of follow-up. Conclusions US-ILVT is an identifiable VT that shares common criteria with ILVT and has a narrow QRS interval. Some US-ILVT cases appeared after common ILVT ablation. It is a reverse type of common ILVT (orthodromic form) with baseline morphological abnormalities that might provide a potential substrate for such VT.",
keywords = "ablation, left fascicle, left upper septum, ventricular tachycardia, verapamil",
author = "Talib, {Ahmed Karim} and Akihiko Nogami and Suguru Nishiuchi and Shinya Kowase and Kenji Kurosaki and Yumie Matsui and Satoshi Kawada and Atsuyuki Watanabe and Masatsugu Nozoe and Kikuya Uno and Atsuhiko Yagishita and Yasuteru Yamauchi and Yoshihide Takahashi and Taishi Kuwahara and Atsushi Takahashi and Koji Kumagai and Shigeto Naito and Tetsuya Asakawa and Yukio Sekiguchi and Kazutaka Aonuma",
year = "2015",
month = "10",
day = "1",
doi = "10.1016/j.jacep.2015.05.011",
language = "English",
volume = "1",
pages = "369--380",
journal = "JACC: Clinical Electrophysiology",
issn = "2405-5018",
publisher = "Elsevier USA",
number = "5",

}

TY - JOUR

T1 - Verapamil-Sensitive Upper Septal Idiopathic Left Ventricular Tachycardia Prevalence, Mechanism, and Electrophysiological Characteristics

AU - Talib, Ahmed Karim

AU - Nogami, Akihiko

AU - Nishiuchi, Suguru

AU - Kowase, Shinya

AU - Kurosaki, Kenji

AU - Matsui, Yumie

AU - Kawada, Satoshi

AU - Watanabe, Atsuyuki

AU - Nozoe, Masatsugu

AU - Uno, Kikuya

AU - Yagishita, Atsuhiko

AU - Yamauchi, Yasuteru

AU - Takahashi, Yoshihide

AU - Kuwahara, Taishi

AU - Takahashi, Atsushi

AU - Kumagai, Koji

AU - Naito, Shigeto

AU - Asakawa, Tetsuya

AU - Sekiguchi, Yukio

AU - Aonuma, Kazutaka

PY - 2015/10/1

Y1 - 2015/10/1

N2 - Objectives This study sought to demonstrate the prevalence, mechanism, and electrocardiographic and electrophysiological characteristics of upper septal idiopathic left fascicular ventricular tachycardia (US-ILVT). Background ILVT is classified into left anterior and posterior types with no clear data about US-ILVT. Methods Among 193 ILVT patients, we identified 12 patients (6.2%; age 41 ± 22 years, 7 men) with US-ILVT. Results Of 12 patients with US-ILVT, 6 patients (50%) had previous history of radiofrequency catheter ablation for common ILVT. Sustained VT (cycle length: 349 ± 53 ms) was seen in all patients with a QRS interval slightly wider (104 ± 18 ms) than that during sinus rhythm (90 ± 19 ms). The VT exhibited an identical QRS configuration as sinus rhythm in 6 (50%) and incomplete right bundle branch block configuration in another 6. His-ventricular interval during VT was always shorter than that during sinus rhythm (27 ± 5 ms vs. 47 ± 10 ms). Purkinje potentials were activated in a reverse direction to that of common ILVT; namely, the diastolic potential (P1) was activated retrogradely but the pre-systolic potential (P2) was activated antegradely. At the left upper-middle ventricular septum, P1 potential was recorded during VT, preceding the QRS by 54 ± 20 ms. Radiofrequency catheter ablation at that site eliminated the VT with no recurrence during a 58 ± 35 months of follow-up. Conclusions US-ILVT is an identifiable VT that shares common criteria with ILVT and has a narrow QRS interval. Some US-ILVT cases appeared after common ILVT ablation. It is a reverse type of common ILVT (orthodromic form) with baseline morphological abnormalities that might provide a potential substrate for such VT.

AB - Objectives This study sought to demonstrate the prevalence, mechanism, and electrocardiographic and electrophysiological characteristics of upper septal idiopathic left fascicular ventricular tachycardia (US-ILVT). Background ILVT is classified into left anterior and posterior types with no clear data about US-ILVT. Methods Among 193 ILVT patients, we identified 12 patients (6.2%; age 41 ± 22 years, 7 men) with US-ILVT. Results Of 12 patients with US-ILVT, 6 patients (50%) had previous history of radiofrequency catheter ablation for common ILVT. Sustained VT (cycle length: 349 ± 53 ms) was seen in all patients with a QRS interval slightly wider (104 ± 18 ms) than that during sinus rhythm (90 ± 19 ms). The VT exhibited an identical QRS configuration as sinus rhythm in 6 (50%) and incomplete right bundle branch block configuration in another 6. His-ventricular interval during VT was always shorter than that during sinus rhythm (27 ± 5 ms vs. 47 ± 10 ms). Purkinje potentials were activated in a reverse direction to that of common ILVT; namely, the diastolic potential (P1) was activated retrogradely but the pre-systolic potential (P2) was activated antegradely. At the left upper-middle ventricular septum, P1 potential was recorded during VT, preceding the QRS by 54 ± 20 ms. Radiofrequency catheter ablation at that site eliminated the VT with no recurrence during a 58 ± 35 months of follow-up. Conclusions US-ILVT is an identifiable VT that shares common criteria with ILVT and has a narrow QRS interval. Some US-ILVT cases appeared after common ILVT ablation. It is a reverse type of common ILVT (orthodromic form) with baseline morphological abnormalities that might provide a potential substrate for such VT.

KW - ablation

KW - left fascicle

KW - left upper septum

KW - ventricular tachycardia

KW - verapamil

UR - http://www.scopus.com/inward/record.url?scp=84945270591&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84945270591&partnerID=8YFLogxK

U2 - 10.1016/j.jacep.2015.05.011

DO - 10.1016/j.jacep.2015.05.011

M3 - Article

AN - SCOPUS:84945270591

VL - 1

SP - 369

EP - 380

JO - JACC: Clinical Electrophysiology

JF - JACC: Clinical Electrophysiology

SN - 2405-5018

IS - 5

ER -