Abstract
Monomorphic ventricular tachycardia (VT) in patients with a previous history of a myocardial infarction (MI) is commonly caused by reentry circuits in myocardial scar area or its borders. However, in some cases, VTs after MI have reentrant circuits mediated by Purkinje fibers: bundle branch reentry, interfascicular reentry, intrafascicular reentry, and focal Purkinje VT.1 Bogun and colleagues2 assessed 81 consecutive patients with monomorphic VT after MI. They found that Purkinje fibers may play a major role in the reentry circuit of postinfarction VT characterized by narrow QRS morphologies.
Highlights
Monomorphic ventricular tachycardia (VT) in patients with a previous history of a myocardial infarction (MI) is commonly caused by reentry circuits in myocardial scar area or its borders
The HD Grid catheter is useful for mapping scar-related VT after MI and Purkinje-related VT, which requires a precise mapping of the Purkinje fiber network
A–G: The activation map revealed that the impulse propagated retrogradely from the VT exit site to the left posterior Purkinje fibers and another propagated from the VT exit site to the apical-anterior wall site via the endocardium
Summary
Monomorphic ventricular tachycardia (VT) in patients with a previous history of a myocardial infarction (MI) is commonly caused by reentry circuits in myocardial scar area or its borders. KEYWORDS Catheter ablation; High-density 3D mapping; Mid-diastolic potential; Purkinje-related ventricular tachycardia; Ventricular tachycardia after myocardial infarction (Heart Rhythm Case Reports 2021;7:232–236) Purkinje-related ventricular tachycardia (VT) after myocardial infarction (MI) is similar to left posterior fascicular VT, as the reentry circuit includes the Purkinje fiber network.
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