EP Fellows Curriculum: Tips and Tricks on Ablation of Fascicular PVCs/VT-EP Fellows Curriculum: Tips and Tricks on Ablation of Fascicular PVCs/VT

EP Fellows Curriculum: Tips and Tricks on Ablation of Fascicular PVCs/VT

Video Transcription

Video Summary

In this video, the speaker discusses the different types of arrhythmias related to the His-Purkinje system. Specifically, they focus on fascicular ventricular tachycardia (VT) and its characteristics. They discuss the different categories of fascicular VT, including posterior VT, anterior VT, and upper septal VT. They explain the conceptual model of fascicular VT, where a reentry circuit is created in the His-Purkinje system and exits further down the myocardium. The speaker also discusses the induction, mapping, and ablation strategies for fascicular VT, as well as the challenges in targeting the specific sites for ablation. They highlight the importance of differentiating fascicular VT from other arrhythmias, such as aberrant conduction or idiopathic PVCs, and discusses the use of verapamil in diagnosing and treating fascicular VT. The speaker also mentions the potential association between fascicular VT and false tendons, as well as the use of intracardiac echo in locating and targeting specific sites for ablation. Finally, they touch upon the non-reentrant form of fascicular tachycardia, which may be automatic or triggered by pacing. They emphasize the importance of conscious sedation during these procedures and the value of ice guidance in identifying targets.

Keywords

arrhythmias

His-Purkinje system

fascicular ventricular tachycardia

reentry circuit

ablation strategies

verapamil

intracardiac echo

conscious sedation