Fascicular VT

Fascicular VT
- aka
1. Verapamil sensitive VT
2. Idiopathic Left VT
3. Idiopathic Fascicular VT
4. Belhassen's VT

features:
1. VT that does not usually revert spontaneously to NSR
and sustains for long periods, often for days
2. RBBB form with left axis (90%) or right axis
3. QRS duration relatively narrow (130-160ms)
4. verapamil usually terminates VT

mechanism:
re-entry in the region of
1. posterior fascicle of the left bundle branch = left axis (90%)
2. anterior fascile = right axis

third variety is the rarest:
Septal fascicular VT = normal axis

Treatment
1. Verapamil SR 240mg daily
* long-term verapamil = will not prevent recurrence
2. Radiofrequency catheter ablation: treatment of choice