Change in QRS morphology as a marker of spontaneous elimination in verapamil-sensitive idiopathic left ventricular tachycardia

Hiroshi Kawakami, Takeshi Aiba, Kohei Ishibashi, Ikutaro Nakajima, Mitsuru Wada, Tsukasa Kamakura, Yuko Inoue, Koji Miyamoto, Hideo Okamura, Satoshi Nagase, Takashi Noda, Yoshihiro Kokubo, Yoshihiro Miyamoto, Satoshi Yasuda, Shiro Kamakura, Kengo Kusano

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Verapamil-sensitive idiopathic left ventricular tachycardia (verapamil-ILVT) is thought to be due to a reentry within the LV fascicular system. Radiofrequency catheter ablation (RFCA) is effective for elimination of the VT; however, a long-term prognosis of patients with verapamil-ILVT is still unclear. Methods and results: Eighty consecutive verapamil-ILVT patients (62 men, 31 ± 12 years of age, LVEF: 65 ± 4%) were enrolled. Seventy-six (95%) cases of VT involved right bundle branch block and left axis deviation. We retrospectively analyzed changes in the QRS duration (ΔQRS-d) and QRS axis (ΔQRS-axis) during follow-up and compared them with recurrence of VT. During a mean follow-up period of 10 years (2–32 years), no sudden death or heart failure occurred. Fifty-one (64%) patients underwent RFCA, and 46 (90%) of them had no VT without any medication after RFCA. The ΔQRS-d (16 ± 2 vs. 8 ± 1 ms, P = 0.24) and ΔQRS-axis (20 ± 4 vs. 4 ± 3 degrees, P = 0.23) were not different in patients with no VT (VT[–]) and those with recurrence of VT (VT[+]). However, in the remaining 29 patients without RFCA, VT was spontaneously eliminated in 16 patients. The ΔQRS-d (30 ± 6 vs. 6 ± 1 ms, P = 0.002) and ΔQRS-axis (23 ± 4 vs. 5 ± 2 degrees, P = 0.001) were significantly larger in VT(–) patients compared to VT(+) patients during follow-up. Conclusions: Some verapamil-ILVT patients who show QRS morphology changes over the follow-up period may become free from VT without any invasive or pharmacological treatments, suggesting that further altered LV fascicular conduction might eliminate the reentry of verapamil-ILVT.

Original languageEnglish
Pages (from-to)446-455
Number of pages10
JournalJournal of Cardiovascular Electrophysiology
Volume29
Issue number3
DOIs
Publication statusPublished - 2018 Mar
Externally publishedYes

Keywords

  • catheter ablation
  • idiopathic LV tachycardia
  • normal ventricle
  • ventricular tachycardia
  • verapamil

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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