Br Heart J 1991;65:231-3
231
Low energy catheter ablation of right ventricular outflow tract tachycardia Arif J Ahsan, David Cunningham, Edward Rowland
Abstract A 38 year old woman with a structurally normal heart presented with near syncope and had right ventricular outflow tract tachycardia. She was intolerant of antiarrhythmic medication and underwent low energy catheter ablation. Six non-arcing shocks of 25J were delivered to the right ventricular outflow tract. No further ventricular tachycardia occurred during a follow up of seven months without antiarrhythmic treatment.
antiarrhythmic medication and in whom low energy catheter ablation was successful.
Case report CLINICAL PRESENTATION
A 38 year old woman was referred because of two episodes of near syncope that occurred on exertion. She had also experienced several episodes of dizziness lasting a few seconds, She palpitation. noticeable without complained of dyspnoea but she could climb 20 stairs. She smoked 20 cigarettes per day. Clinical examination was entirely normal. The electrocardiogram at rest and chest x ray were Ventricular tachycardia of left bundle branch normal. Echocardiography showed normal configuration and with an inferior axis in chamber sizes and normal valves. Radiopatients with structurally normal hearts is nuclide ventriculography at rest was normal recognised as a clinical syndrome.' 3 It is for both ventricles. Magnetic resonance usually brought on by stress and exercise and imaging showed normal left and right normally has a good prognosis.' Unlike most ventricular dimensions, wall thickness, wall ventricular tachycardia, it can be suppressed thickening, and ejection fractions. She performed the modified Bruce protocol by treatment with # blockers and calcium channel blockers. These features are on a treadmill. Before she mounted the consistent with a catecholamine sensitive treadmill her heart rate increased to 100 beats/ focus arising from the right ventricular outflow minute and she developed frequent unifocal tract. Experience with surgery and catheter ventricular extrasystoles with a left bundle branch configuration and inferior axis (fig 1). ablation in this condition is limited. We describe a patient with right ventricular After two minutes and 45 seconds of stage I outflow tract tachycardia and a structurally she developed frequent bouts of nonnormal heart who was intolerant of sustained ventricular tachycardia (cycle length aVR
l
V4
V1
.. I
III
Royal Brompton National Heart and Lung Hospital, London A J Ahsan D Cunningham E Rowland
II
aVL
V2
V5
Mt'
aVF
V3
V6
Rhythm strip: I | 25 mmis; cm/mV
Correspondence to Dr Arif J Ahsan, Department of Pacing and Electro-
physiology, Royal Brompton National Heart and Lung Hospital, Sydney Street, London SW3 6NP.
Figure I Twelve lead electrocardiogram showing frequent ventricular extrasystoles with a left bundle branch block and inferi.or axis configuration.
Ahsan, Cunningham, Rowland
232
II
l1
J
11tS~~~~~~~~~~
aVR V
V6-W
231
Low energy catheter ablation of right ventricular outflow tract tachycardia Arif J Ahsan, David Cunningham, Edward Rowland
Abstract A 38 year old woman with a structurally normal heart presented with near syncope and had right ventricular outflow tract tachycardia. She was intolerant of antiarrhythmic medication and underwent low energy catheter ablation. Six non-arcing shocks of 25J were delivered to the right ventricular outflow tract. No further ventricular tachycardia occurred during a follow up of seven months without antiarrhythmic treatment.
antiarrhythmic medication and in whom low energy catheter ablation was successful.
Case report CLINICAL PRESENTATION
A 38 year old woman was referred because of two episodes of near syncope that occurred on exertion. She had also experienced several episodes of dizziness lasting a few seconds, She palpitation. noticeable without complained of dyspnoea but she could climb 20 stairs. She smoked 20 cigarettes per day. Clinical examination was entirely normal. The electrocardiogram at rest and chest x ray were Ventricular tachycardia of left bundle branch normal. Echocardiography showed normal configuration and with an inferior axis in chamber sizes and normal valves. Radiopatients with structurally normal hearts is nuclide ventriculography at rest was normal recognised as a clinical syndrome.' 3 It is for both ventricles. Magnetic resonance usually brought on by stress and exercise and imaging showed normal left and right normally has a good prognosis.' Unlike most ventricular dimensions, wall thickness, wall ventricular tachycardia, it can be suppressed thickening, and ejection fractions. She performed the modified Bruce protocol by treatment with # blockers and calcium channel blockers. These features are on a treadmill. Before she mounted the consistent with a catecholamine sensitive treadmill her heart rate increased to 100 beats/ focus arising from the right ventricular outflow minute and she developed frequent unifocal tract. Experience with surgery and catheter ventricular extrasystoles with a left bundle branch configuration and inferior axis (fig 1). ablation in this condition is limited. We describe a patient with right ventricular After two minutes and 45 seconds of stage I outflow tract tachycardia and a structurally she developed frequent bouts of nonnormal heart who was intolerant of sustained ventricular tachycardia (cycle length aVR
l
V4
V1
.. I
III
Royal Brompton National Heart and Lung Hospital, London A J Ahsan D Cunningham E Rowland
II
aVL
V2
V5
Mt'
aVF
V3
V6
Rhythm strip: I | 25 mmis; cm/mV
Correspondence to Dr Arif J Ahsan, Department of Pacing and Electro-
physiology, Royal Brompton National Heart and Lung Hospital, Sydney Street, London SW3 6NP.
Figure I Twelve lead electrocardiogram showing frequent ventricular extrasystoles with a left bundle branch block and inferi.or axis configuration.
Ahsan, Cunningham, Rowland
232
II
l1
J
11tS~~~~~~~~~~
aVR V
V6-W
