分支型室速Fascicular-VT-2013-Final

• FP-V interval between SR and tachycardia
Same location and different mechanism
• ? PAC or PVC wk.baidu.comr entrainment
• ? Linear ablation • ? Change of QRS morphology for successes
CS D RVA ABL P
STIM
I AVF V1
HRA
HIS P HIS M HIS D CS P
CS D
RVA ABL D ABL P STIM
I AVF V1 CS 9,0
CS 1,2 RVA 3,4 RVA 1,2 HIS 3,4 HIS 2,3 HIS 1,2
H-V:50ms
H-V:0ms
PACE, Vol. 34 May 2011
Before
I II III
AVR
I II III
AVR
AVL AVF V1 V2 V3 V4 V5 V6
ABL P
ABL D
AVL AVF V1 V2 V3 V4 V5 V6
ABL P
ABL D
52ms
24ms
38ms
38ms
His P
His M
His P
During Ablation
?Block at site 1 SR-LAFB, Tachy-RBBB with LPFB FP-V (SR): behind V FP-V (Tach): same ? Block at site 2 SR-LAFB Tachy-LAFB FP-V (SR): same FP-V (tach): longer
Fascicular Tachycardia
Modified from Tawara
Verapamil-Sensitive Left Posterior fascicular VTs
Verapamil-Sensitive Left Anterior Fascicular VTs
AKIHIKO NOGAMI, M.D.
HRA
HV:-40ms
HIS 3,4 HIS 2,3 HIS 1,2 CS 9,0
H
H
CS 1,2 RVA
Beat 5
HB RBB
AVN LAF
Beat 4
HB RBB LPF
AVN LAF
LPF
Summary
• HV interval during tachycardia
Same location and different mechanism
AVN LAF
LPF
I
AVF
V1 CS 9,0
CS 1,2
FP-V:32ms
RVA 3,4 RVA 1,2 HIS 3,4 HIS 2,3
FP-V:32ms
HIS 1,2
ABL 1,2
ABL 3,4
AVN HB LAF RBB LPF RBB HB
AVN LAF
LPF
I II III AVR AVL AVF V1 V2 V3 V4 V5 V6
AVN HB LAF RBB LPF RBB HB
AVN LAF
LPF
I AVF V1 CS 9,0
CS 1,2 RVA 3,4 RVA 1,2 HIS 3,4 HIS 2,3 HIS 1,2 ABL 1,2 ABL 3,4
FP-V:20ms
FP-V:20ms
AVN HB LAF RBB LPF RBB HB
Before
After
I II III AVR AVL AVF V1 V2 V3 V4 V5
I AVF V1 HIS P HIS M HIS D CS P
CS D RVA
V6
HIS D
32ms 65ms
ABL D
ABL P STIM
45ms 45ms
HIS P RVA
I AVF V1 HRA HIS M HIS D CS P
His M
His D CS 9,0
His D CS 9,0
CS 1,2
RB 3,4
RB 1,2
CS 1,2
RB 3,4
RB 1,2
200ms
I II III
AVR
AVL
AVF
V1 V2 V3 V4 V5 V6
ABL P ABL D
52ms
24ms
38ms
38ms
His P
His M
His D CS 9,0
1
2
3
AVN HB HB
AVN
AVN
LAF
LAF
HB
LAF
RBB LPF
RBB LPF
RBB LPF
Mapping: FP early
Mapping: FP not early
Mapping: FP not early
AKIHIKO NOGAMI, M.D.
PACE, Vol. 34 May 2011
I II III AVR AVL AVF V1 V2 V3 V4 V5 V6
AVR AVL AVF
V1 V2 V3 V4 V5 V6
ABL D
ABL P
29ms
17ms
18ms
18ms
His P
His M
His D
CS 9,0
CS 1,2 RB 3,4
RB 1,2
200ms
AVN AVN
HB
HB
LAF RBB LPF RBB LPF
LAF
FV interval SR=extrasystole
LAF
LPF
FV interval SR>extrasystole
FV interval SR=extrasystole
I II III
AVR
AVL AVF V1 V2 V3 V4 V5 V6 ABL P ABL D His P
38ms
38ms
His M
His D CS 9,0
CS 1,2 RB 3,4 RB 1,2
I II V1
ABL 1,2 ABL 3,4 HRA HIS 3,4 HIS 2,3 HIS 1,2 CS 9,0
FP
FP HV:-40ms
CS 1,2 RVA
I
Beat 1
2
3
4
5
II
V1 ABL 1,2
V
CL 375ms FP CL 370ms
CL 380ms
FP
CL 370ms
ABL 3,4
I II III
AVR AVL AVF
V1 V2 V3 V4 V5 V6
ABL D
ABL P
29ms
17ms
18ms
18ms
His P
His M
His D
CS 9,0
CS 1,2 RB 3,4
RB 1,2
200ms
AVN AVN AVN AVN
HB
HB
HB LAF
HB
LAF
RBB LPF RBB
LAF RBB RBB LPF LPF
Before ablation
After ablation
HV (20ms)-(-20ms), FP-V: SR=tachy
PAC: PVC:, or entrainment
PVC: FP: entrained will terminate tachy
PAC: FP; entrained will terminate tachy
CS 1,2 RB 3,4
RB 1,2
200ms
AVN AVN AVN AVN
HB
HB
HB LAF
HB
LAF RBB LPF RBB
LAF RBB RBB LPF LPF
LAF
LPF
HV interval SR>extrasystole
HV interval SR=extrasystole
I II III