Idiophatic left fascicular ventricular tachycardia

Abstract

Background: Idiopathic left fascicular ventricular tachycardia (ILFVT) is a ventricular tachycardia (VT) characterized by right bundle branch block (RBBB) and left axis deviation (LAD) on electrocardiogram (ECG). It occurs predominantly in young males (15–40 years old) without structural heart disease.[1] It represents 10%–15% of all idiopathic left VT seen in clinical practice today.[2] Management and treatment: A 27-year-old man presented to the emergency department of the Mongolian Japan Hospital with palpitations and shortness of breathing. When the patient was connected to a control monitor, a non-sinus rhythm and narrow complex tachycardia was recorded. Standard treatments were performed according tachycardia guidelines, but they were ineffective. A diagnosis of fascicular tachycardia was suspected based on ECG findings of narrow complex tachycardia, RBBB and LAD. Oral verapamil was given which terminated the arrhythmia. Conclusion: Prompt recognition of this arrhythmia is necessary because it is curable with catheter ablation. In general, if standard methods including vagal maneuvers and adenosine administration fail to convert the arrhythmia and the 12 lead ECG shows a right bundle branch block picture with left axis deviation, a diagnosis of fascicular tachycardia should be considered. In the acute setting, first-line pharmacological treatment is Verapamil. Catheter ablation is an effective treatment method and is recommended when symptoms are severe or when pharmacological treatment is ineffective or poorly tolerated.