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Two Different Reentrant Circuits of Ventricular Tachycardia in a Patient with an Extensive Anterior Infarction: Evaluation Using Electrical Catheter Ablation Techniques
Author(s) -
FUJIKI AKIRA,
TANI MASANAO,
MIZUMAKI KOICHI,
SASAYAMA SHIGETAKE,
AIZAWA YOSHIFUSA
Publication year - 1992
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.1992.tb04169.x
Subject(s) - medicine , ventricular tachycardia , cardiology , catheter ablation , ablation , reentrancy , catheter , tachycardia , reentry , radiofrequency catheter ablation , anesthesia , surgery , computer science , programming language
Two morphologically distinct sustained ventricular tachycardias were initiated by programmed stimulation during attempted catheter ablation in a patient with an old anterior myocardial infarction. Right bundle branch block configuration of ventricular tachycardia, which was identical to the spontaneously occurring tachycardia, was initiated and displayed fragmented mid‐diastolic potential at the apicolateral left ventricular site. Evidence of a critical slow conduction area was observed during delivery of electrical stimuli to this area. Following a 150‐joule electrical shock delivered to this area, right bundle branch block pattern of ventricular tachycardia was no longer inducible but a new sustained monomorphic ventricular tachycardia with left bundle branch block pattern was initiated. The mid‐diastolic fragmented activity at the ablation site became electrical activation of bystander area that was not participating in the left bundle branch block type of the ventricular tachycardia circuit. The critical slow conduction area was identified at the apicoseptal left ventricular site that was separated more than 5 cm from the ablation site. We speculate that two morphologically distinct sustained monomorphic ventricular tachycardias may be due to two different reentrant circuits and not the different expression of the same circuit.