Author + information
- Received April 17, 2017
- Revision received November 27, 2017
- Accepted November 28, 2017
- Published online March 19, 2018.
- Rajeev K. Pathak, MBBS, PhDa,
- Joe Fahed, MDa,
- Pasquale Santangeli, MD, PhDa,
- Matthew C. Hyman, MD, PhDa,
- Jackson J. Liang, DOa,
- Maciej Kubala, MDa,
- Tatsuya Hayashi, MDa,
- Daniele Muser, MDa,
- Manina Pathak, MBBS, MPHb,
- Arshneel Kochar, MDa,
- Simon A. Castro, MDa,
- Fermin C. Garcia, MDa,
- David S. Frankel, MDa,
- Gregory E. Supple, MDa,
- Robert D. Schaller, DOa,
- David Lin, MDa,
- Michael P. Riley, MDa,
- Rajat Deo, MDa,
- Andrew E. Epstein, MDa,
- Erica S. Zado, PA-Ca,
- Sanjay Dixit, MDa,
- David J. Callans, MDa and
- Francis E. Marchlinski, MDa,∗ ()
- aCardiovascular Division, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
- bCardiovascular Division, University of Adelaide, Adelaide, Australia
- ↵∗Address for correspondence:
Dr. Francis E. Marchlinski, Hospital of the University of Pennsylvania, 9 Founders Pavilion – Cardiology, 3400 Spruce Street, Philadelphia, Pennsylvania 19104.
Objectives This study reports the long-term outcome of patients with bundle branch re-entrant tachycardia (BBRT) who underwent catheter ablation for ventricular tachycardia (VT).
Background BBRT is an uncommon mechanism of VT. Data on long-term outcomes of patients with BBRT treated with catheter ablation are insufficient.
Methods Between 2005 and 2016, 32 patients had a sustained VT due to a bundle branch re-entrant mechanism. Diagnosis of BBRT was established per standard published criteria.
Results The mode of presentation was syncope in 17 patients (53%) and palpitations in 15 (47%). BBRT was inducible in all subjects, and successful ablation of the right bundle branch in 19 patients (59%) or the left bundle branch in 13 patients (41%) was performed. During follow-up of 95 ± 36 months, 6 patients (19%) died, 3 of progressive heart failure and 3 of noncardiac causes. Recurrent VT due to BBRT did not occur in any patient. At baseline, 25 patients (78%) had a prolonged HV interval (>55 ms) and 7 (22%) had a normal HV interval (≤55 ms). In patients with a normal HV interval, there was only 1 death (due to malignancy), and no one developed heart block during 90 ± 36 months of follow-up. Ten patients (31%) had normal left ventricular (LV) function (LV ejection fraction ≥50%), and 22 (69%) had depressed LV function (LV ejection fraction <50%). No deaths were recorded in patients with normal LV function (5 with no implantable cardioverter-defibrillator) compared with 6 deaths among patients with depressed LV function (n = 22; p = 0.07).
Conclusions Radiofrequency ablation of the bundle branch is an effective therapy for treatment of BBRT. Sustained BBRT can be seen in patients with normal LV systolic function and HV interval with excellent long-term outcomes after ablation.
- bundle branch re-entrant tachycardia
- catheter ablation
- implantable cardioverter-defibrillator
- ventricular tachycardia
Dr. Pathak is supported by an early career fellowship from the National Health and Medical Research Council of Australia. This work was supported in part by the Mark S. Marchlinski EP Research Fund at the University of Pennsylvania. All authors have reported that they have no relationships relevant to the contents of this paper to disclose. This study was presented as an abstract at the Heart Rhythm Society Meetings, Chicago, Illinois (May 2017).
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received April 17, 2017.
- Revision received November 27, 2017.
- Accepted November 28, 2017.
- 2018 American College of Cardiology Foundation
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