Left upper septal fascicular VT
Из Catheter Ablation of Cardiac Arrhythmias, 3 Ed:
Цитата:
The last type of verapamil-sensitive fascicular VT is an upper septal fascicular VT. This rare form of VT shows a relatively narrow QRS configuration, with a normal or right axis deviation (Fig. 18.3) [3,7]. In this form of VT, the retrograde His bundle activation precedes the QRS complex (Fig. 18.11). If retrograde ventriculoatrial conduction is also present, it may mimic atrioventricular nodal reentry or atrioventricular reciprocating tachycardia. To avoid a misdiagnosis, recognition of the sequence of the His bundle activation and measurement of the H–V interval during tachycardia are important. In upper septal fascicular VT, a potential is recorded from the upper left ventricular septum that precedes the His bundle potential, at a site where the left bundle potential is recorded during
sinus rhythm. Figure 18.11 shows the intracardiac electrograms at the successful ablation site of the upper septal fascicular VT. At a left upper septal site, a left bundle branch potential was recorded during sinus rhythm, and during VT preceded the QRS by 35 ms. Ablation at this site eliminated the VT without LBBB or atrioventricular block. A potentially similar VT was reported by Shimoike et al. [7]. The latter case differed in that the QRS morphology had a left bundle normal QRS axis during VT. However, the QRS was narrow and the successful ablation site was similar to ours.
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P.S. Из своей практики могу припомнить пару случаев фасцикулярной ЖТ, чувствительной к верапамилу, у пациентов с ПИКС - у ВСЕХ в анамнезе был НИМ.
24.05.2009, 20:22
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