[Ventricular tachycardias originating in the his-purkinje system. Bundle branch reentrant ventricular tachycardias and fascicular ventricular tachycardias].

Abstract	Ventricular tachycardias (VT) associated with the His-Purkinje system may occur in patients with and without organic heart disease. The former may encounter bundle branch reentrant VT, a macroreentrant VT utilizing the specific conduction system. It frequently occurs in patients with preexisting conduction disturbance such as complete left bundle branch block and may be eliminated by catheter ablation of the right bundle branch. After successful ablation, patient's prognosis depends on the presence or absence of structural heart disease.In patients without structural heart disease, VT with right bundle branch block pattern and superior axis, referred to as idiopathic left ventricular tachycardia, is observed. It is a reentrant VT utilizing the posterior left fascicle and the Purkinje network. The two treatment options include antiarrhythmic drug therapy with verapamil or curative catheter ablation.Another form of ventricular arrhythmia originating in the Purkinje network is idiopathic ventricular fibrillation (IVF). Focal triggers from the right and left ventricular Purkinje network induce premature ventricular contractions inducing IVF. This is amenable to catheter ablation leading to a significant reduction in ICD (implantable cardioverter defibrillator) interventions in sudden cardiac death survivors.
Authors	Boris Schmidt, Kyoung Ryul Julian Chun, Karl-Heinz Kuck, Feifan Ouyang
Journal	Herz (Herz) Vol. 34 Issue 7 Pg. 554-60 (Nov 2009) ISSN: 1615-6692 [Electronic] Germany
Vernacular Title	Ventrikuläre Tachykardien mit Ursprung im spezifischen Reizleitungssystem : Schenkeltachykardien und faszikuläre ventrikuläre Tachykardien.
PMID	20091255 (Publication Type: English Abstract, Journal Article, Review)
Topics	Bundle of His (physiopathology) Bundle-Branch Block (diagnosis, physiopathology, therapy) Catheter Ablation Defibrillators, Implantable Humans Models, Cardiovascular Purkinje Fibers (physiopathology) Tachycardia, Atrioventricular Nodal Reentry (complications, diagnosis, physiopathology)

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