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Related Experiment Videos

Anatomic substrate for idiopathic left ventricular tachycardia

R K Thakur1, G J Klein, C A Sivaram

  • 1Arrhythmia Service, University Hospital, London, Canada.

Circulation
|February 1, 1996
PubMed
Summary

Idiopathic left ventricular tachycardia (ILVT) is linked to a false tendon in the left ventricle. Ablation of this tendon successfully treated most patients, suggesting it causes this unique arrhythmia.

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Area of Science:

  • Cardiology
  • Cardiac Electrophysiology
  • Medical Imaging

Background:

  • Idiopathic left ventricular tachycardia (ILVT) presents with specific ECG findings (RBBB morphology, left axis deviation) and is inducible from the atrium.
  • A previous case reported successful surgical resection of a left ventricular false tendon in an ILVT patient.
  • The role of false tendons in the genesis of ILVT remains to be elucidated.

Purpose of the Study:

  • To investigate the presence and characteristics of left ventricular false tendons in patients with ILVT.
  • To determine if false tendons are a consistent finding in ILVT and to assess their potential role in the arrhythmia's mechanism.

Main Methods:

  • Transthoracic and/or transesophageal echocardiography was performed on 15 patients with ILVT undergoing catheter ablation.

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  • Echocardiograms were analyzed for the presence, location, and thickness of left ventricular false tendons.
  • A control group of 671 patients without ILVT was used for comparison.

    • Main Results:

    • All 15 ILVT patients exhibited a false tendon extending from the posteroinferior left ventricular free wall to the septum.
    • False tendons were thicker in ILVT patients compared to the control group (5/15 vs. 2/34).
    • Catheter ablation targeting the posteroapical septum resulted in a cure in 14 out of 15 ILVT patients.

    Conclusions:

    • A left ventricular false tendon is a consistent finding in patients with ILVT.
    • This anatomical anomaly is likely responsible for the genesis of this unique ventricular tachycardia.
    • Potential mechanisms include conduction through the false tendon or Purkinje fiber network stretch.