13th International Congress
THE "NEW FRONTIERS"
OF ARRHYTHMIAS 1998

January 24-31, 1998
Marilleva, Trento, Italy

RT-150

Radiofrequency catheter ablation of "right ventricular tachycardias"

Maurizio Lunati, Maurizio Gasparini*, Giovanni Magenta, Giuseppe Cattafi, Rita Vecchi, Giuseppe Gadaleta.
Servizio di Elettrofisiologia ed Elettrostimolazione, Dipartimento Cardiotoracico "A. De Gasperis", Ospedale Maggiore Cá Granda, Milano-Niguarda, *Unita Operativa di Cardiologia, Istituto Clinico Humanitas, Rozzano, Milano, Italy

Introduction^1,2

Tachyarrhythmias (TA) that exhibit a left bundle branch block (LBBB) configuration are provoked by mechanisms that activate the right ventricle in advance of the left ventricle. The differential diagnosis of TA with LBBB morphology includes many well defined (and not so well defined) syndromes. Clinical manifestations, diagnostic studies and electrophysiological evaluation generally provide clues that lead to the correct rhythm diagnosis (and mechanism) and to the best approaches to therapy.

Among the several entities that should be considered in the differential diagnosis one has to consider:

1. ventricular tachycardias (VT) originated in the right ventricle (RV);

- idiopathic;
- related to arrhythmogenic right ventricular cardiomyopathy;
- scar related (post-surgical repair of congenital heart disease);

2. supraventricular tachycardias (SVT);

- functional and/or preexistent conduction block or delay in the left bundle branch with any SVT;
- WPW syndrome (right-sided or septal AV accessory pathway);
- Mahaim and Mahaim-like tachycardias.

We will briefly define the clinical and electophysiological characteristics of ventricular TA originated in the RV, analyse the results of radiofrequency catheter ablation (RFCA) of these arrhythmias and then present our experience in this setting.