Successful catheter ablation of focal ventricular tachycardia originating from right bundle branch without making right bundle branch block, using pharmacologic.

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Successful catheter ablation of focal ventricular tachycardia originating from right bundle branch without making right bundle branch block, using pharmacologic induction by landiolol Shigeo Watanabe, MD, Tsugutoshi Suzuki, MD, PhD, Yoko Yoshida, MD, Yoshihide Nakamura, MD HeartRhythm Case Reports Volume 3, Issue 12, Pages 586-589 (December 2017) DOI: 10.1016/j.hrcr.2017.09.006 Copyright © 2017 Heart Rhythm Society Terms and Conditions

Figure 1 A: The surface 12-lead electrocardiogram revealed sustained ventricular tachycardia (VT) occasionally with sinus capture (*). VT rate was 150 beats/min. B: The first and second beat was VT beat and the third beat was sinus capture. During VT, the His potential preceded the QRS onset, and the sequence of the His potential was inverted from sinus capture. During VT, the H–V duration was shorter than that of sinus capture. HeartRhythm Case Reports 2017 3, 586-589DOI: (10.1016/j.hrcr.2017.09.006) Copyright © 2017 Heart Rhythm Society Terms and Conditions

Figure 2 A: The sharp Purkinje potential of the successful ablation site (ABL1-2) preceded the His potential by 17 ms. B: The surface lead electrocardiogram during radiofrequency current revealed rapid firing of ventricular tachycardia with or without right bundle branch block (RBBB). Several seconds after radiofrequency current was stopped, heart rhythm was converted to sinus rhythm without RBBB. C: Fluoroscopy revealed successful ablation site targeting the earliest Purkinje potential located at the anterior portion of the right ventricular septum and at the same level as that of the His potential. HeartRhythm Case Reports 2017 3, 586-589DOI: (10.1016/j.hrcr.2017.09.006) Copyright © 2017 Heart Rhythm Society Terms and Conditions

Figure 3 The electrocardiograms and schemas of the His–Purkinje system during ventricular tachycardia (VT) are shown. Immediately after right bundle branch block (RBBB) appeared during sinus rhythm, the QRS morphology of VT changed to RBBB type. After 20 seconds, when RBBB partially improved during sinus rhythm, the QRS morphology of VT changed to that of the sinus rhythm at baseline. After 80 seconds, when RBBB disappeared during sinus rhythm, the QRS morphology of VT returned to the original left bundle branch block configuration. Star, origin of VT; doublet, wounded portion of RBB; arrow, electrical conduction on the His–Purkinje system; dotted arrow, slow electrical conduction. AVN = atrioventricular node; His = His bundle; LBB = left bundle branch; RBB = right bundle branch. HeartRhythm Case Reports 2017 3, 586-589DOI: (10.1016/j.hrcr.2017.09.006) Copyright © 2017 Heart Rhythm Society Terms and Conditions