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The normal cardiac rhythm is a synchronized electrical activity that facilitates the regular and coordinated contraction of the heart muscle. This process is essential for efficient blood circulation throughout the body. The fundamental elements involved in establishing and maintaining this rhythm include the unique electrical properties of cardiac muscle cells, the sinoatrial (SA) node's pacemaker function, the specialized conducting system, and the ionic mechanisms underlying each phase...
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In vivo mapping of human polymorphic ventricular tachycardia.

Luigi Pannone1, Cinzia Monaco1, Domenico Giovanni Della Rocca1

  • 1Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Heart Rhythm Research Brussels, Postgraduate Program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium.

Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing
|December 18, 2025
PubMed
Summary

Polymorphic ventricular tachycardia (PMVT) in patients with normal QTc is primarily maintained by rotational activity at the ventricular apex. Changes in QRS morphology and amplitude result from the fusion of apical and non-apical electrical wavefronts.

Keywords:
Brugada syndromeECG imagingPolymorphic ventricular tachycardiaSudden cardiac deathVentricular arrhythmias

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Imaging

Background:

  • Polymorphic ventricular tachycardia (PMVT) presents with characteristic QRS changes.
  • Understanding PMVT mechanisms in patients with a normal QTc interval is crucial.

Purpose of the Study:

  • To investigate the underlying mechanisms of human PMVT using in vivo ECG imaging (ECGI) mapping.
  • To correlate observed electrical activity with QRS morphology and amplitude changes.

Main Methods:

  • ECGI mapping was performed on five patients experiencing PMVT with a normal QTc.
  • Exclusion criteria included long QT, PVC-induced PMVT, and acute ischemia.
  • Phase mapping analyzed rotational and focal electrical activities during PMVT episodes.

Main Results:

  • Five PMVT episodes were mapped, with a mean duration of 5.9 seconds.
  • Stable rotors were observed at the ventricular apex during the initial phase of PMVT.
  • Reductions in QRS amplitude correlated with non-apical activity and fusion of apical and non-apical wavefronts.

Conclusions:

  • Rotational activity originating from the ventricular apex is the primary mechanism sustaining human PMVT.
  • Observed alterations in QRS complex morphology and amplitude are secondary to the fusion of electrical wavefronts from different origins.