Purkinje Arrhythmia Origin Made Easy

See Article by Ma et al Tachycardia originating from the fascicles or His-Purkinje system includes a wide spectrum of arrhythmias such as ventricular fibrillation and ventricular tachycardia (VT) which could be monomorphic or polymorphic with various substrates, locations, and mechanisms.1 The most common type of reentrant fascicular tachycardia is left posterior fascicular VT (LPF-VT) which was recognized as an electrocardiographic entity by Zipes et al,2 who defined its diagnostic triad as following: (1) induction with atrial pacing, (2) right bundle branch block and a left-axis configuration, and (3) manifestation in patients without structural heart disease. In 1981, Belhassen et al3 reported verapamil sensitivity, as a fourth identifying feature of this tachycardia. To ablate LPF-VT, there are 2 different successful sites defined by 2 different strategies (Figure). The first strategy was reported by Nakagawa et al4 who targeted the earliest presystolic Purkinje potentials that can be recorded at the apical-inferior septum of the left ventricle during VT. The second strategy was reported by Tsuchiya et al5 who emphasized the significance of a late diastolic potential at the basal septal region close to the main trunk of the …