Verapamil-Sensitive Left Posterior Fascicular Ventricular Tachycardia Associated with Paroxysmal Atrial Fibrillation

Abstract

Case Report: A 37-year-old man with the wide QRS tachycardia visited to our hospital. The wide QRS tachycardia had emerged with paroxysmal Atrial fibrillation (pAf). The QRS configuration during the wide QRS tachycardia was a right bundle branch block pattern with left-axis deviation. Verapamil could terminate the wide QRS tachycardia. We diagnosed the wide QRS tachycardia verapamil-sensitive left posterior fascicular Ventricular Tachycardia (VT). Verapamil-sensitive left posterior fascicular VT had always emerged coexistence with pAf. During the electrophysiological study, verapamil-sensitive posterior fascicular VT was induced by programmed atrial stimulation. We performed segmental pulmonary vein antrum isolation during sinus rhythm. After the isolation of pulmonary veins, the radiofrequency application to the VT circuit was performed. VT could be terminated by radiofrequency application where the earliest purkinje potential preceded the onset of earliest surface QRS by 12 ms during VT. No VT was induced after the radiofrequency applications. Conclusions: This VT is the rare case of verapamil-sensitive posterior fascicular VT associated with pAf. We successfully ablated these double tachycardias.