JACC. Case reports · 2026
Narrow-QRS Ventricular Tachycardia Due to Microreentry After Iatrogenic Right Bundle Injury.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Kim Myoung Jung, Jung Wonyoung, Kim Juwon, Kim Ju Youn, Park Seung-Jung, On Young Keun, Park Kyoung-Min
Аннотация
BACKGROUND: Ventricular tachycardia (VT) after ablation near the conduction system can present with a relatively narrow QRS complex and mimic supraventricular tachycardia (SVT), making diagnosis and management challenging.
CASE SUMMARY: A 26-year-old man with 2 prior ablations for idiopathic premature ventricular complexes presented with incessant narrow-QRS tachycardia and left ventricular systolic dysfunction. Despite antiarrhythmic drugs and repeated cardioversion, the tachycardia persisted. Electrophysiologic study demonstrated ventriculoatrial dissociation, fixed His-His return intervals, and concealed fusion during atrial overdrive pacing. High-density mapping identified earliest activation at the mid-right bundle within a voltage border zone. Targeted radiofrequency ablation at this site terminated the VT and restored sinus rhythm, with complete recovery of ventricular function.
DISCUSSION: This case illustrates an iatrogenic conduction system-related microreentrant VT masquerading as SVT, and it highlights the value of pacing maneuvers and high-density mapping for mechanistic diagnosis and precise ablation.
TAKE-HOME MESSAGES: VT after prior right ventricular ablation may present with a narrow-QRS complex and mimic SVT. High-density mapping and pacing maneuvers can reveal an iatrogenic conduction system-related reentrant circuit and guide effective ablation.
CASE SUMMARY: A 26-year-old man with 2 prior ablations for idiopathic premature ventricular complexes presented with incessant narrow-QRS tachycardia and left ventricular systolic dysfunction. Despite antiarrhythmic drugs and repeated cardioversion, the tachycardia persisted. Electrophysiologic study demonstrated ventriculoatrial dissociation, fixed His-His return intervals, and concealed fusion during atrial overdrive pacing. High-density mapping identified earliest activation at the mid-right bundle within a voltage border zone. Targeted radiofrequency ablation at this site terminated the VT and restored sinus rhythm, with complete recovery of ventricular function.
DISCUSSION: This case illustrates an iatrogenic conduction system-related microreentrant VT masquerading as SVT, and it highlights the value of pacing maneuvers and high-density mapping for mechanistic diagnosis and precise ablation.
TAKE-HOME MESSAGES: VT after prior right ventricular ablation may present with a narrow-QRS complex and mimic SVT. High-density mapping and pacing maneuvers can reveal an iatrogenic conduction system-related reentrant circuit and guide effective ablation.