Left coronary cusp ablation for elimination of left ventricular summit premature ventricular complex.

We first reported that epicardial LAVA in the LV summit can be mapped and PVC was completely eliminated by RF ablation above the left coronary cusp using single catheter technique.

Purkinje-Related Ventricular Tachycardia and Ventricular Fibrillation: Solved and Unsolved Questions.

Of the monomorphic ventricular tachycardias, there are 4 specific tachycardias related to the Purkinje system: 1) idiopathic verapamil-sensitive fascicular ventricular tachycardia (FVT); 2) non-re-entrant FVT; 3) bundle branch re-entry and interfascicular re-entry; and 4) Purkinje-mediated VT in structural heart disease. Verapamil-sensitive FVT is classified into 4 types according to the location of the circuit: 1) left posterior type; 2) left anterior type; 3) left upper septal type;and 4) reverse type. And, in the left anterior and posterior types, there are septal and papillary muscle subtypes. Although macro-re-entry has been reported to be the mechanism underlying verapamil-sensitive FVT, recording the entire circuit is challenging. One possible reason is that the Purkinje-muscle junction may penetrate the myocardial layer as a part of the circuit. The Purkinje network may thus play an important role in the initiation and maintenance of ventricular fibrillation. Further, it has been reported that the development and the abnormalities of the Purkinje system are associated with the arrhythmogenesis of ventricular fibrillation. Furthermore, it has been reported that catheter ablation of trigger ventricular premature complexes, and/or "de-networking" of the Purkinje system, can be used as electrical bailout therapy. There is a hypothesis that the intramural Purkinje system is involved in the generation of J waves. Nevertheless, as there are still unresolved issues that must be debated and accurately analyzed, this review aims to discuss the solved and unsolved questions related to Purkinje-related arrhythmias.

Catheter Ablation for Ventricular Tachycardia Involving the His-Purkinje System: Fascicular and Bundle Branch Reentrant Ventricular Tachycardia.

The Purkinje system has been found to mediate several monomorphic ventricular tachycardias (VTs). These include fascicular VTs and bundle branch reentrant (BBR) VTs. Previous studies have revealed that VTs involving the His-Purkinje system are composed of multiple discrete subtypes that are best differentiated by their mechanism, drug effect, VT morphology, and successful ablation site. Recognition of the heterogeneity of these VTs and their unique characteristics should facilitate the appropriate diagnosis and therapy and help guide catheter ablation therapy. In this article, we focus on the latest updates of the mechanisms underlying left ventricle fascicular VTs and BBR-VTs as well as the latest catheter ablation techniques.

Reverse-Type Left Posterior Fascicular Ventricular Tachycardia: A New Electrocardiographic Entity.

OBJECTIVES: This study sought to demonstrate a new type of verapamil-sensitive fascicular ventricular tachycardia (VT) with a reverse circuit. BACKGROUND: Left posterior fascicular ventricular tachycardia (LPFVT) is the most common form of verapamil-sensitive fascicular VT. Reverse-type LPFVT has not been reported. METHODS: We searched for a reverse-type LPFVT among 242 patients with verapamil-sensitive VT from February 2006 to September 2019. RESULTS: Three patients had a reverse-type LPFVT (cycle lengths: 340, 360, and 340 ms). QRS configuration during VT was narrow (140, 150, and 140 ms) and exhibited rSr' morphology in V1 with an early precordial transition and inferior axis. Two of 3 patients had common-type LPFVT. During reverse-type LPFVT, the earliest ventricular activation was the left superior middle septum. Fragmented Purkinje potentials (P1) buried within the local ventricular electrogram were recorded with an activation sequence from the apex to the base and were linked to the subsequent left ventricular septal activation. After radiofrequency catheter ablation at P1 during LPFVT, the reverse-type LPFVT also became noninducible. In 1 patient with only the reverse-type LPFVT, radiofrequency catheter ablation at the earliest LV activation site suppressed VT. These findings suggest that this new type of verapamil-sensitive fascicular VT shares a re-entrant circuit with a reverse direction of common LPFVT with an intramural exit site at the superior middle septum. CONCLUSIONS: Reverse-type LPFVT can occur. If common LPFVT exists, diastolic P1 during LPFVT can be a common target of ablation. If only reverse-LPFVT is inducible, the earliest ventricular activation site can be a target.

A case with transient anterolateral wall ballooning syndrome; new variant form of Takotsubo cardiomyopathy?

Proposed to be a new variant form of the left ventricular apical ballooning syndrome or the so-called "Takotsubo cardiomyopathy" the presented case has several clinical characteristics resembling previous reported cases of this particular syndrome except for its unique anterolateral wall akinesis and sparing basal and apical wall motion with preserved left ventricular ejection fraction.

A quality-improvement project use of a computerized medical database and reminder letters to increase preventive care use in kaiser permanente patients.

CONTEXT: Previous studies have suggested that preventive health care measures may be improved by proactive patient-reminder systems and use of electronic medical databases. OBJECTIVE: Our objective was to use Kaiser Permanente's (KP's) electronic medical databases to improve the preventive health care delivered to KP patients in Honolulu, HI. DESIGN: Patients not seen by their primary care physician in more than one year ("low-utilizing patients") and overdue for preventive health care services were identified using KP's electronic medical databases. These patients were then sent letters requesting that they obtain these services. Response rates and results of their screening tests were tracked. RESULTS: Of 309 letters sent, 84 (27.2%) patients responded. Of the 260 patients who were reminded of overdue immunizations (tetanus, pneumonia, influenza, or a combination of these), 51 (19.6%) came in to obtain them. Ten of the 37 (27.0%) women overdue for breast cancer screening came in for mammograms. Eleven of the 109 (10.1%) patients overdue for colorectal cancer screening completed fecal occult blood testing. CONCLUSION: Outreach letters that target low-utilizing patients identified by an electronic medical database may be an efficient and cost-effective way of improving patient use rates of preventive health care.