The Beat Webinar Series - Episode 6 - An Uncommon Case of Idiopathic Left Fascicular Tachycardia (On Demand)-The Beat Episode 6

Video Transcription

Video Summary

This webinar presented a case of idiopathic left fascicular tachycardia, which had some atypical features. The patient had a history of unsuccessful catheter ablation at another hospital. During the procedure, the patient had a double tachycardia with fast-slow atrial ventricular nodal reentrant tachycardia (AVNRT) and ventricular tachycardia (VT) . The VT could be terminated with verapamil, indicating verapamil-sensitive idiopathic VT. The mapping showed that the VT originated from the left posterior papillary muscle. There were changes in the QRS morphology during the ablation, indicating the presence of multiple VT morphologies. The successful ablation site was found to be at the posterior papillary muscle. The case highlighted the importance of having multiple electrode catheters for accurate mapping of the VT and the use of verapamil sensitivity to diagnose and treat idiopathic VT. The case also introduced a new classification of left fascicular VT, which includes types originating from the posterior and anterior papillary muscles, in addition to the usual septal origins. Overall, the case demonstrated the complexity and challenges in diagnosing and treating idiopathic left fascicular tachycardia.

Keywords

idiopathic left fascicular tachycardia

atypical features

catheter ablation

double tachycardia

verapamil-sensitive idiopathic VT

posterior papillary muscle

QRS morphology changes

multiple electrode catheters

challenges