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Change in QRS morphology as a marker of spontaneous elimination in verapamil‐sensitive idiopathic left ventricular tachycardia
Author(s) -
Kawakami Hiroshi,
Aiba Takeshi,
Ishibashi Kohei,
Nakajima Ikutaro,
Wada Mitsuru,
Kamakura Tsukasa,
Inoue Yuko,
Miyamoto Koji,
Okamura Hideo,
Nagase Satoshi,
Noda Takashi,
Kokubo Yoshihiro,
Miyamoto Yoshihiro,
Yasuda Satoshi,
Kamakura Shiro,
Kusano Kengo
Publication year - 2018
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.13403
Subject(s) - medicine , qrs complex , cardiology , verapamil , ventricular tachycardia , right bundle branch block , left axis deviation , catheter ablation , electrocardiography , ablation , calcium
Background Verapamil‐sensitive idiopathic left ventricular tachycardia (verapamil‐ILVT) is thought to be due to a reentry within the LV fascicular system. Radiofrequency catheter ablation (RFCA) is effective for elimination of the VT; however, a long‐term prognosis of patients with verapamil‐ILVT is still unclear. Methods and results Eighty consecutive verapamil‐ILVT patients (62 men, 31 ± 12 years of age, LVEF: 65 ± 4%) were enrolled. Seventy‐six (95%) cases of VT involved right bundle branch block and left axis deviation. We retrospectively analyzed changes in the QRS duration (ΔQRS‐d) and QRS axis (ΔQRS‐axis) during follow‐up and compared them with recurrence of VT. During a mean follow‐up period of 10 years (2–32 years), no sudden death or heart failure occurred. Fifty‐one (64%) patients underwent RFCA, and 46 (90%) of them had no VT without any medication after RFCA. The ΔQRS‐d (16 ± 2 vs. 8 ± 1 ms, P = 0.24) and ΔQRS‐axis (20 ± 4 vs. 4 ± 3 degrees, P = 0.23) were not different in patients with no VT (VT[–]) and those with recurrence of VT (VT[+]). However, in the remaining 29 patients without RFCA, VT was spontaneously eliminated in 16 patients. The ΔQRS‐d (30 ± 6 vs. 6 ± 1 ms, P = 0.002) and ΔQRS‐axis (23 ± 4 vs. 5 ± 2 degrees, P = 0.001) were significantly larger in VT(–) patients compared to VT(+) patients during follow‐up. Conclusions Some verapamil‐ILVT patients who show QRS morphology changes over the follow‐up period may become free from VT without any invasive or pharmacological treatments, suggesting that further altered LV fascicular conduction might eliminate the reentry of verapamil‐ILVT.