Tachykardie mit breitem QRS-Komplex – ein ungewöhnlicher Fall

Abstract

Ventricular non-reentrant idiopathic tachycardia (VT) is characterized by an inferior axis and a left bundle branch block pattern in the surface ECG. Thereby the R/S transition is important. While R/S transition in V1 or V2 is typically for a left-sided origin, an R/S transition in V4 or beyond is typically associated with a right-sided origin. The right ventricular outflow tract (RVOT) is the predominant origin of this VT but is also found at left ventricular outflow tract (LVOT). The prognosis is generally good compared to other VT-types.

This case highlights a successful epicardial ablation of a ventricular outflow tract tachycardia via an endocardial approach from the coronary sinus without causing any complications.

Literatur

• 1 Kamakura S, Shimizu W, Matuso K. et al . Localization of optimal ablation site of idiopathic ventricular tachycardia from right and left ventricular outflow tract by body surface ECG.  Circulation. 1998;  98 1525-1533
• 2 Ouyang F, Fotuhi P, Ho S Y. et al . Repetitive monomorphic ventricular tachycardia originating from the aortic sinus cusp: electrocardiographic characterization for guiding catheter ablation.  J Am Coll Cardiol. 2002;  39 500-508
• 3 Berruezo A, Mont L, Nava S. et al . Electrocardiographic recognition of the epicardial origin of ventricular tachycardias.  Circulation. 2004;  109 1842-1847
• 4 Kumagai K, Yamauchi Y, Takahashi A. et al . Idiopathic left ventricular tachycardia originating from the mitral annulus.  J Cardiovasc Electrophysiol. 2005;  16 1029-1036
• 5 Wright M, Hocini M, Yen H o, Haïssaguerre M. Epicardial ablation of left ventricular outflow tract tachycardia via the coronary sinus.  Heart Rhythm. 2009;  6 290-291
• 6 Massoure P L, Jais P, Sacher F, Haissaguerre M. Tachycardia-induced right ventricular cardiomyopathy: epicardial radiofrequency ablation of an unusual and unexpected ventricular tachycardia.  J Cardiovasc Electrophysiol. 2009;  20 813-817