Ventricular tachycardia arising from His-bundle
Sou Takenaka1, Akihiko Ueno1, Ayano Enzan2
1Department of Cardiology IMS Katsushika Heart Center Tokyo Japan.
Journal of Arrhythmia
|June 16, 2023
Summary
Radiofrequency ablation targeting Purkinje potentials during tachycardia can cause left anterior fascicular block. This complication leads to a recurrence of tachycardia with a left-axis deviation, highlighting procedural risks.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiac Arrhythmias
Background:
- Tachycardia management often involves radiofrequency ablation.
- Understanding the electrophysiological relationship between His-bundle and Purkinje potentials is crucial for ablation success.
Purpose of the Study:
- To investigate the electrophysiological characteristics of tachycardia during His-bundle and Purkinje potential recording.
- To evaluate the impact of radiofrequency ablation at specific sites on tachycardia recurrence and potential complications.
Main Methods:
- Recording of His-bundle and Purkinje potentials during tachycardia.
- Radiofrequency energy application at a site with peripheral Purkinje potential recordings relative to His-bundle potentials.
Main Results:
- His-bundle potentials consistently preceded Purkinje potentials during tachycardia.
- Radiofrequency ablation at the targeted site caused temporary cessation of tachycardia.
- A subsequent recurrence of tachycardia with left-axis deviation was observed, attributed to left anterior fascicular block.
Conclusions:
- Ablation targeting Purkinje potentials, when His-bundle potentials are recorded more centrally, carries a risk of inducing left anterior fascicular block.
- This complication can lead to tachycardia recurrence with altered QRS axis, necessitating careful ablation site selection.
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