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Brugada ECG Pattern Unmasked by IV Flecainide in an Individual with Idiopathic Fascicular Ventricular Tachycardia.

Gavin AR, Young GD, McGavigan AD - Indian Pacing Electrophysiol J (2013)

Bottom Line: He had previously been diagnosed with idiopathic fascicular ventricular tachycardia.Intravenous flecainide results in termination of his tachycardia but unmasks a latent type 1 Brugada ECG pattern not seen on his resting ECG.We discuss his subsequent management and the need to consider an alternative diagnosis in individuals with a Brugada type ECG pattern who present with stable monomorphic ventricular tachycardia.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiovascular Medicine, Flinders Medical Centre.

ABSTRACT
A 45-year old man presents with stable monomorphic ventricular tachycardia. He had previously been diagnosed with idiopathic fascicular ventricular tachycardia. Intravenous flecainide results in termination of his tachycardia but unmasks a latent type 1 Brugada ECG pattern not seen on his resting ECG. We discuss his subsequent management and the need to consider an alternative diagnosis in individuals with a Brugada type ECG pattern who present with stable monomorphic ventricular tachycardia.

No MeSH data available.


Related in: MedlinePlus

3D reconstruction and activation map of left the ventricle using the EnSite Velocity System. PA view is on the left and an extreme RAO view with inferior tilt on the right. His potentials recorded from right and left sides of septum are marked as L-His and R-His respectively. Sites with purkinje potentials representing the anterior and posterior fascicles of the left bundle branch are marked as AP and PP respectively. The PP potentials lie close to the red dots which indicate the site of successful ablation. The successful ablation site is proximal to the earliest activation (displayed in white). This is because although the circuit is within the posterior fascicle, the activation times were calculated from near-field ventricular electrograms and not timing of the Purkinje potentials. As such, the earliest ventricular activation is displayed at the ventricular insertion of the Purkinje fibres.
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Figure 2: 3D reconstruction and activation map of left the ventricle using the EnSite Velocity System. PA view is on the left and an extreme RAO view with inferior tilt on the right. His potentials recorded from right and left sides of septum are marked as L-His and R-His respectively. Sites with purkinje potentials representing the anterior and posterior fascicles of the left bundle branch are marked as AP and PP respectively. The PP potentials lie close to the red dots which indicate the site of successful ablation. The successful ablation site is proximal to the earliest activation (displayed in white). This is because although the circuit is within the posterior fascicle, the activation times were calculated from near-field ventricular electrograms and not timing of the Purkinje potentials. As such, the earliest ventricular activation is displayed at the ventricular insertion of the Purkinje fibres.

Mentions: However, following discussion with the electrophysiology service, a diagnostic EPS with a view to ablation of his idiopathic fascicular VT was recommended. Following administration of intravenous isoproterenol, monomorphic VT (CL 260ms) was easily induced on multiple occasions with programmed ventricular stimulation. This VT had an identical morphology to that seen on arrival at the Emergency Department. An externally irrigated ablation catheter (Cool Path Duo, St Jude Medical, St Paul, MN, USA) was advanced retrogradely to the left ventricle and a 3 dimensional (3D) left ventricular geometry and activation map was created using Ensite Velocity (St Jude Medical, St Paul, MN, USA) (Figure 2).


Brugada ECG Pattern Unmasked by IV Flecainide in an Individual with Idiopathic Fascicular Ventricular Tachycardia.

Gavin AR, Young GD, McGavigan AD - Indian Pacing Electrophysiol J (2013)

3D reconstruction and activation map of left the ventricle using the EnSite Velocity System. PA view is on the left and an extreme RAO view with inferior tilt on the right. His potentials recorded from right and left sides of septum are marked as L-His and R-His respectively. Sites with purkinje potentials representing the anterior and posterior fascicles of the left bundle branch are marked as AP and PP respectively. The PP potentials lie close to the red dots which indicate the site of successful ablation. The successful ablation site is proximal to the earliest activation (displayed in white). This is because although the circuit is within the posterior fascicle, the activation times were calculated from near-field ventricular electrograms and not timing of the Purkinje potentials. As such, the earliest ventricular activation is displayed at the ventricular insertion of the Purkinje fibres.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3539402&req=5

Figure 2: 3D reconstruction and activation map of left the ventricle using the EnSite Velocity System. PA view is on the left and an extreme RAO view with inferior tilt on the right. His potentials recorded from right and left sides of septum are marked as L-His and R-His respectively. Sites with purkinje potentials representing the anterior and posterior fascicles of the left bundle branch are marked as AP and PP respectively. The PP potentials lie close to the red dots which indicate the site of successful ablation. The successful ablation site is proximal to the earliest activation (displayed in white). This is because although the circuit is within the posterior fascicle, the activation times were calculated from near-field ventricular electrograms and not timing of the Purkinje potentials. As such, the earliest ventricular activation is displayed at the ventricular insertion of the Purkinje fibres.
Mentions: However, following discussion with the electrophysiology service, a diagnostic EPS with a view to ablation of his idiopathic fascicular VT was recommended. Following administration of intravenous isoproterenol, monomorphic VT (CL 260ms) was easily induced on multiple occasions with programmed ventricular stimulation. This VT had an identical morphology to that seen on arrival at the Emergency Department. An externally irrigated ablation catheter (Cool Path Duo, St Jude Medical, St Paul, MN, USA) was advanced retrogradely to the left ventricle and a 3 dimensional (3D) left ventricular geometry and activation map was created using Ensite Velocity (St Jude Medical, St Paul, MN, USA) (Figure 2).

Bottom Line: He had previously been diagnosed with idiopathic fascicular ventricular tachycardia.Intravenous flecainide results in termination of his tachycardia but unmasks a latent type 1 Brugada ECG pattern not seen on his resting ECG.We discuss his subsequent management and the need to consider an alternative diagnosis in individuals with a Brugada type ECG pattern who present with stable monomorphic ventricular tachycardia.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiovascular Medicine, Flinders Medical Centre.

ABSTRACT
A 45-year old man presents with stable monomorphic ventricular tachycardia. He had previously been diagnosed with idiopathic fascicular ventricular tachycardia. Intravenous flecainide results in termination of his tachycardia but unmasks a latent type 1 Brugada ECG pattern not seen on his resting ECG. We discuss his subsequent management and the need to consider an alternative diagnosis in individuals with a Brugada type ECG pattern who present with stable monomorphic ventricular tachycardia.

No MeSH data available.


Related in: MedlinePlus