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Bundle branch reentry ventricular tachycardia with two distinct left bundle branch block morphologies
1Department of Cardiology, Cleveland Clinic Foundation, Ohio 44195, USA.
Journal of Cardiovascular Electrophysiology
|June 1, 1997
Summary
Bundle branch reentry ventricular tachycardia (VT) can present with multiple QRS morphologies, even with right bundle branch activation. This case highlights the need for thorough ablation to address all reentrant circuit variations.
Area of Science:
- Electrophysiology
- Cardiac Arrhythmias
- Interventional Cardiology
Background:
- Bundle branch reentry ventricular tachycardia (VT) is typically treated with radiofrequency ablation.
- Multiple QRS morphologies in VT are known when left bundle branch activation occurs anterogradely.
- Right bundle branch activation with multiple VT morphologies has not been previously reported.
Observation:
- An electrophysiologic study in a patient with dilated cardiomyopathy and VT revealed typical bundle branch reentry.
- A unique right bundle branch recording was observed only during macroreentrant beats or VT.
- VT recurred post-ablation with a different QRS morphology, indicating the same reentry mechanism.
Findings:
- The study documented VT with more than one QRS morphology during anterograde activation via the right bundle branch.
- A second ablation was necessary to completely eliminate the persistent bundle branch reentry VT.
- Preexisting right bundle branch disease and a dilated heart may contribute to this phenomenon.
Implications:
- This case demonstrates that bundle branch reentry VT can exhibit diverse QRS morphologies, even with right bundle activation.
- Comprehensive electrophysiologic evaluation is crucial to ensure complete ablation of all reentrant pathways.
- Understanding these variations is vital for successful management of complex VT cases.