A novel method to identify the origin of ventricular tachycardia from the left fascicular system

Background There are well-described ablation strategies to treat left fascicular tachyarrhythmia (LFTA); however, a method to predict the origin is less well characterized. Objective The purpose of this study was to predict the origin of LFTAs by measuring the HV interval during normal sinus rhythm (NSR) and LFTAs. Methods A predicted value of the earliest presystolic potential (PP) time was calculated using the HV interval during NSR and LFTAs [(HVNSR +HVLFTA )/2]. The earliest retrograde PP was mapped during LFTAs, and the relationship between the predicted and the mapped value was correlated. Results Twenty-one consecutive patients with LFTAs were included in this study. Four patients (19%) had tachycardia originating from the left anterior fascicle; the mean HV interval was 50.3 ± 8.3 and 30.3 ± 11.6 ms during NSR and tachycardia, respectively. The mapped retrograde PP during LFTAs preceded the onset of the surface electrocardiogram by 34 ± 9.4 ms. Seventeen patients (81%) had tachycardia originating from the left posterior fascicle; the mean HV interval was 49.2 ± 4.6 and −4.5 ± 13.6 ms during NSR and LFTAs, respectively. Nineteen patients with successful ablation were analyzed; the mean HV interval was −0.9 ± 16.8 and 49.5 ± 4.6 ms during LFTAs and NSR, respectively. The predicted value was similar to the mapped value (24.4 ± 9.1 ms vs 25.2 ± 8.1 ms; P = .76). The predicted value was well correlated with that from the target site ( r = 0.97; P < .001). Conclusion The earliest retrograde PP site for the ablation of LFTAs can be predicted measuring the HV interval during NSR and LFTAs. Successful ablation can be performed during NSR for patients with LFTAs inducible at baseline but noninducible during mapping.