• L M Rodriguez, J L Smeets, C Timmermans, H J Trappe, and H J Wellens.
• Department of Cardiology, University Hospital Maastricht, The Netherlands. LM.rodriguez@cardio.azm.nl
• J. Cardiovasc. Electrophysiol. 1996 Dec 1; 7 (12): 1211-6.

IntroductionIdiopathic ventricular tachycardia (VT) originating in or close to the anterior fascicle of the left bundle is rare. A patient with no structural heart disease and VT with a right bundle branch block configuration and right-axis deviation underwent an electrophysiologic examination.Methods And ResultsBoth endocardial activation mapping during VT and pacemapping were performed via a transseptal approach to localize the site of origin of the VT. Endocardial recordings of the His bundle and the posterior and anterior fascicles of the left bundle branch revealed an origin of the VT in or close to the anterior fascicle. The Purkinje potential at that site preceded the QRS complex by 20 msec, with pacemapping showing an optimal match between the paced rhythm and the clinical VT. RF energy delivered at this site terminated the VT. A left anterior hemiblock appeared after RF ablation. Ten months later, the patient is free from recurrences of VT.ConclusionsIdiopathic VT originating in or close to the anterior fascicle was cured by RF ablation. A Purkinje potential preceding the QRS during tachycardia and an optimal pacemap were used to guide RF ablation.

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