Ablation strategies in a patient with Belhassen tachycardia

The verapamil-sensitive Belhassen tachycardia is a ventricular reentrant tachycardia, involving left-sided Purkinje fibers and abnormal Purkinje or myocardial tissue. Ablation is feasible, targeting a diastolic fascicular potential in the apical left ventricle.

We report on a 13-year-old girl with left posterior fascicular ventricular tachycardia. Tachycardia stopped during ablation, targeting a left-sided distal fascicular potential, and afterward, there was no tachycardia inducible, but it reoccurred 2 weeks later. During a second procedure, we transected the left posterior fascicle by a line, also with early success. After a further recurrence, we ablated a longer proximal segment of the left posterior fascicle including its most proximal electrograms. After this ablation, there was no further recurrence.

In refractory patients, proximal ablation of the posterior fascicle might be indicated.