Benign ventricular tachycardia

There are a group of conditions which give rise to sustained ventricular tachycardia but, in the absence of any accompanying structural heart disease, are not life threatening. All are amenable to probable curative therapy with catheter ablation.

Figure 19.4 Endocardial geometry with superimposed isopotential map recorded using the non-contact mapping system (Endocardial Solutions Inc) in a patient undergoing ablation for right ventricular outflow tract tachycardia. The area coloured white effectively represents the initiation site for the arrhythmia. Note that the "virtual electrograms" demonstrate a characteristic early (relevant to surface ECG) "QS" pattern confirming site of earliest activation.

Figure 19.4 Endocardial geometry with superimposed isopotential map recorded using the non-contact mapping system (Endocardial Solutions Inc) in a patient undergoing ablation for right ventricular outflow tract tachycardia. The area coloured white effectively represents the initiation site for the arrhythmia. Note that the "virtual electrograms" demonstrate a characteristic early (relevant to surface ECG) "QS" pattern confirming site of earliest activation.

Right ventricular outflow tract tachycardia

The term right ventricular outflow tract tachycardia is purposefully descriptive. Occasionally the arrhythmia source is in the left ventricular outflow and ECG features do not always allow discrimination. Arrhythmia control may be achieved with drugs, principally p blockers, if ablation is refused. There is at least a presentational overlap between arrhythmogenic right ventricular dysplasia, which should be considered as a possible diagnosis if catheter ablation of the target arrhythmia is unsuccessful, the arrhythmia is recurrent, or there is imaging evidence of right ventricular abnormality.3 Inducibility of the arrhythmia is variable. Sophisticated mapping tools may aid catheter ablation.26

Idiopathic left ventricular tachycardia

Idiopathic left ventricular tachycardia is also of unknown aetiology but is considered to be a focal triggered arrhythmia and commonly emanates from the interventricular septum. It too is optimally managed by catheter ablation in symptomatic individuals27 (fig 19.4).

Fascicular tachycardia

Fascicular tachycardia is also highly amenable to curative catheter ablation. The tachycardia mechanism involves a re-entrant circuit intimately related to the posterior fascicles of the left conduction system and gives characteristic ECG features of a right bundle branch block, superior access ventricular tachycardia. It may occur in the setting of coronary or other myocardial

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