Long‐Term Outcome After Catheter Ablation for Left Posterior Fascicular Ventricular Tachycardia Without Development of Left Posterior Fascicular Block

Abstract

Catheter ablation of left posterior fascicular (LPF) ventricular tachycardia (VT) is commonly performed during tachycardia. This study reports on the long-term outcome of patients undergoing ablation of LPF VT targeting the earliest retrograde activation within the posterior Purkinje fiber network during sinus rhythm (SR). This study retrospectively analyzed 24 consecutive patients (8 female; mean age 26 ± 11 years) referred for catheter ablation of electrocardiographically documented LPF VT. Programmed stimulation was performed to induce tachycardia, while mapping and ablation was aided by use of a 3D electroanatomical mapping system. Catheter ablation targeted the earliest potential suggestive of retrograde activation within the posterior Purkinje fiber network (retro-PP) recorded along the posterior mid-septal left ventricle during SR if LPF VT was noninducible. Overall, 21/24 (87.5%) patients underwent successful catheter ablation in SR targeting the earliest retro-PP, while 3/24 (12.5%) patients were successfully ablated during tachycardia. In none of the patients, ablation resulted in LPF block. No procedure-related complications occurred. After a median follow-up period of 8.9 (4.8-10.9) years, 22/24 (92%) patients were free from recurrent VT. In patients presenting with LPF VT, ablation of the earliest retro-PP along the posterior mid-septal LV during SR results in excellent long-term outcome during a median follow-up period of almost 9 years.