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Bundle‐Branch Reentrant Ventricular Tachycardia: A Possible Mechanism of Flecainide Proarrhythmic Effect
Author(s) -
SAOUDI N.,
GALTIER M.,
HIDDEN F.,
GERBER L.,
LETAC B.
Publication year - 1988
Publication title -
journal of electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 0892-1059
DOI - 10.1111/j.1540-8167.1988.tb01498.x
Subject(s) - flecainide , medicine , cardiology , reentry , qrs complex , anesthesia , amiodarone , ventricular tachycardia , tachycardia , bundle branch block , left bundle branch block , electrocardiography , atrial fibrillation , heart failure
A 42‐year‐old male with cardiomyopathy and paroxysmal at atrial fibrillation was on chronic oral amiodarone therapy (200 mg/day) and received an additional 400 mg of flecainide per day because his nondocumented palpitations recurred. Ten syncopes occurred in the two following months and the patient was referred for electrophysiologic study. The basic H#V interval was prolonged (80 msec) and QRS slightly prolonged (110 msec). Programmed ventricular stimulation consistently found a critical SH delay (260 msec) that was followed by a left bundle‐branch block type of QRS. The latter was always preceded by a His deflection (H), thereby evoking His‐Purkinje reentry. Three premature beats induced a rapid (cycle length 270 msec), sustained, poorly tolerated ventricular tachycardia (VT) with a QRS morphology identical to the bundle‐branch reentrant phenomenon. Each ventricular electrogram was preceded by an H, H‐V varying from 100 to 130 msec. Three weeks after flecainide withdrawal, the H‐V interval was 60 msec and no VT was inducible. This observation is representative of a proarrhythmic effect of flecainide in association with amiodarone. Bundle‐branch reentry ventricular tachycardia is the most likely mechanism of arrhythmia‐aggravation in this observation. It could have been induced because of intraventricular depression of conduction.