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Slow entry of calcium in partially depolarized Purkinje fibres is thought to mediate the genesis of fascicular ventricular tachycardia (VT). Verapamil reverses this influx and is effective at terminating VT. However, the efficacy of verapamil is variable and it may not be well tolerated due to side-effects, as seen in the case presented here. Idiopathic left posterior fascicular VT (ILPFVT) can be treated by localised catheter ablation in the left ventricular septum with a high success rate. Ablating at sites with the earliest retrograde-Purkinje potential (retro-PP) can be used for guiding successful ablation. In the case presented here, ablation at a site with a late retro-PP resulted in a successful ablation. This indicates that ablation at any site with retro-PP along the left ventricular posterior fascicular network may be sufficient in disrupting the ILPFVT circuit.

Identification of the Retrograde Circuit in Left Posterior Fascicular Ventricular Tachycardia as a Target for Ablation