ABSTRACT
Ventricular tachycardia due to reentry within the bundle branches occurs in the presence of left ventricular dilatation and conduction alterations in the His-Purkinje system. A macro-reentry is formed by the His bundle, left and right bundles and ventricular myocardium. The anatomical substrate of this arrhythmia is ventricular dilatation. However, it may appear in healthy hearts. Alterations of intraventricular conduction are reflected by a prolongation of PR intenval and bundle branch block in the surface EKG and prolongation of HV interval in the endocavitary registry. During tachycardia, His activation precedes ventricular activation. We report three patients aged 55,58 and 78 years old with a dilated cardiomyopathy and ventricular tachycardia due to reentry within the bundle branches. All had a left bundle branch block and a prolonged HV internal. The arrhythmia was induced during the study in two patients. All were subjected to radiofrequency fulguration of the right branch of the His bundle. After fulguration, two remained with a pattern of complete right bundle branch block and one with a complete intermittent AV block. All three are free of arrhythmic events
Subject(s)
Humans , Male , Middle Aged , Tachycardia, Atrioventricular Nodal Reentry/diagnosis , Tachycardia, Ventricular/diagnosis , Tachycardia, Ventricular/therapy , Catheter Ablation , Electrocardiography/methods , ElectrocoagulationABSTRACT
Background: Accessory pathways are muscular connections between auricles and ventricles, present in different points of mitral and tricuspid annuluses. These pathways participate in 50 percent of Paroxysmal supraventricular tachycardias and the definitive cure of the arrhythmia is their ablation. Aim: To report our experience in patients with right accessory pathways. Patients and methods: 50 consecutive patients treated between 1990 and 1996 are reported. Eight had a history of syncope, two had a diagnosis of Epstein disease and 36 had a pre-excitation in the surface electrocardiogram. Results: Fifty four accessory pathways were identified, since four patients had two pathways. Twenty four pathways were posteroseptal, 15 were lateral, 9 were medioseptal and 6 were anteroseptal. One patient had also a nodal reentry tachycardia. Fulguration was attempted in 39 patients and it was finally successful in 32. Three patients required more than one session. There were six relapses and all were successfully ablated in a second session. A mean of 28 radiofrequency applications were done (range 1- 76), mean laboratory time was 6 hours and mean radioscopy time was 70 min. Four patients had a transient atrioventricular conductor blockade. Conclusions: Radiofrequency ablation of accessory pathways has a high degree of success and a low rate of complications
Subject(s)
Humans , Male , Female , Child, Preschool , Adolescent , Adult , Middle Aged , Arrhythmia, Sinus/surgery , Catheter Ablation/methods , Electrocoagulation/methods , Atrial Flutter/physiopathology , Tachycardia, Supraventricular/surgery , Atrial Fibrillation/physiopathology , Tachycardia, Paroxysmal/surgeryABSTRACT
Patients and methods: We report six patients (five male), aged 35 years old as a mean, with idiopathic left ventricular tachycardia that were subject to conventional electrophysiological studies with atrial and ventricular simulation programs and radiofrequency fulguration, between December 1993 and May 1996. Results: The mean lapse of disease was 24 months and five patients received antiarrytmic medications previously. All tachycardias had a morphology with an image of right bundle branch block. Radiofrequency fulguration was done after obtaining a satisfactory pace mapping of at least 11 of the 12 superficial EKG derivations. The procedure was successful in five patients and two had a relapse. One of the relapsed patients was successfully fulgurated again. Conclusions: Radiofrequency fulguration for idiopathic ventricular tachycardias is a safe and effective therapeutic procedure
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Tachycardia, Ventricular/physiopathology , Tachycardia, Ventricular/surgery , Catheter Ablation/methods , Electrophysiology/methodsABSTRACT
Nine patients (8 males) whose ages ranged from 6 to 72 years old were studied. Two patients had an operated congenital cardiopathy, 2 had high blood pressure, 1 has no subject previously to radiofrequency ablation due to a left paraspecific pathway; 1 developed a cardiac failure secondary to tachycardia and 3 relapses in the first month after the procedure, of these, 2 patients were succesfully treated again. After a mean follow up of 4.5 months, these patients are asymptomatic and without antiarrythmic drugs. Analyzis of obtained signals, showed that radiofrequency that interrupted atrial flutter always occurred in zones of double potentials. Radiofrequency ablation is an effective tretament for atrial flutter and the zone of succesful ablation is associated to the presence of double atrial potentials