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Ablation of Ischemic Ventricular Tachycardia Using a Multipolar Catheter and 3-dimensional Mapping System for High-density Electro-anatomical Reconstruction

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Verapamil for ventricular tachycardia.

Huck Chin Chew¹, Swee Han Lim

¹Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore 169608, Singapore. chinnjing@pacific.net.sg

The American Journal of Emergency Medicine

|June 5, 2007

Summary

Fascicular ventricular tachycardia (VT), a type of idiopathic VT, can be misdiagnosed. Intravenous verapamil effectively terminates fascicular VT, aiding in correct diagnosis and management.

Area of Science:

Cardiology
Electrophysiology
Emergency Medicine

Background:

Fascicular ventricular tachycardia (VT), also known as left VT, is a subclass of idiopathic VTs.
It is often misdiagnosed as supraventricular tachycardia (SVT) with aberrant conduction or other VT types.
First described in 1979, its characteristic termination with intravenous verapamil led to terms like Belhassen VT.

Observation:

Two patient cases are presented: one misdiagnosed with SVT, the other correctly diagnosed with fascicular VT.
Both patients experienced successful medical conversion of their fascicular VT using intravenous verapamil.
The study highlights diagnostic challenges and successful treatment outcomes.

Findings:

Fascicular VT can be mistaken for other tachyarrhythmias, underscoring the need for accurate diagnostic criteria.

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Intravenous verapamil is a highly effective treatment for terminating fascicular VT.

Prompt recognition and appropriate management are crucial for patient outcomes.

Implications:

Improved awareness among emergency medicine physicians regarding fascicular VT is essential.
Verapamil should be considered a primary therapeutic option for suspected fascicular VT.
Distinguishing fascicular VT from ischemic VT is critical for appropriate patient management and treatment strategies.