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Transvenous catheter ablation of the His bundle in ventricular tachycardia
Insights
Transvenous His bundle ablation effectively treated recurrent ventricular tachycardia (VT) refractory to conventional therapies. This procedure, involving catheter ablation of the His bundle, successfully eliminated VT in all patients studied.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Device Technology
Background:
- Recurrent ventricular tachycardia (VT) poses a significant therapeutic challenge, often refractory to standard treatments.
- Identifying the initiating mechanism of VT during rapid atrial rhythms is crucial for effective management.
- Transthoracic direct-current shocks were frequently required, indicating the severity and refractoriness of VT in these patients.
Abstract:
The usefulness of transvenous catheter ablation of the His bundle in three patients with recurrent ventricular tachycardia (VT), in which the initiating mechanism was recognized during a rapid atrial rhythm, is reported. Tachycardia was refractory to conventional treatment and required transthoracic direct-current shocks in all patients. In patient No. 1 double tachycardia (atrial flutter and VT) was documented and VT was easily induced by rapid atrial pacing. In patients Nos. 2 and 3 initiation of VT during junctional reciprocating and atrial tachycardia, respectively, was observed. Interruption of the His bundle was performed by means of fulguration. Stable atrioventricular (AV) block was observed in patient No. 1 after the ablative procedure; patient No. 2 showed anterograde conduction over a posterior septal accessory pathway with no evidence of conduction over the normal conduction system in both the anterograde and retrograde directions. In patient No. 3, transient AV block was observed; AV conduction resumed 2 days later and the cardiac rhythm showed persistent ectopic atrial tachycardia with second-degree AV block. Patients Nos. 1 and 2 underwent pacemaker implantation, but patient No. 2 was not pacemaker dependent. After the procedure, VT no longer occurred in any of the patients (follow-up: 2 years, 5 months, and 6 months).