Left ventricular tachycardia
Author Ольга Кияница
Left ventricular tachycardia is a separate form of paroxysmal monomorphic ventricular tachycardia. It has many other meanings, for example, septal jaundice, verapamil-sensitive jaundice, intraphasticular CT, but the most famous term is left ventricular fascicular tachycardia (LPH).
Of the left ventricular idiopathic tachycardia, the fascicular form most often occurs. In most cases it develops at a young age, with the usual pathology of the heart, as a rule, absent.
Of the idiopathic ventricular tachycardia, LPHF accounts for up to 15%. The disease is more common in men, quite rarely in the elderly, while there is no association with physical activity, as attacks often develop during rest. To get an answer to the question of how dangerous left ventricular tachycardia is, it is worth considering this topic in more detail.
Video Ventricular tachycardia. Symptoms, Symptoms and Treatment Methods
Description of left ventricular tachycardia
At the heart of the pathology is the mechanism of re-enter, which generates a circular circulation of the pulse, which contributes to an increase in the frequency of heart contractions.
The contour of the pathological passage of the excitation wave is most often correlated with the posterior-lower branching of the right leg of the hyza beam. Not so often affected by the left leg of the bundle of Guillaume.
Symptoms of left ventricular tachycardia
During an attack, the heart rate is on average 170 bpm. In rare cases, the pathology proceeds asymptomatic. The following symptoms are most commonly identified:
- paroxysms last for 30 seconds or more;
- in almost 80% of patients there is a provocation of physical activity attacks;
- tachycardia most often occurs during daytime.
Often the symptoms of left ventricular tachycardia are transmitted normally, the course of the disease is relatively favorable. In rare cases, syncope and presyncupal conditions arise, or general deterioration of well-being develops. The latter is mainly due to the existing organic pathology of the heart.
Types / photos of left ventricular tachycardia
The separation of LPHF into forms is based on the morphology of electrocardiography, in particular on the anatomical location of the re-entry path:
1. In almost 95% of cases, the posterior left ventricular fascicular tachycardia is defined - the contour of the circulation of the pathological pulse begins at the top of the interventricular septum, where the verapamil-sensitive area is determined.With it, the pulse goes down to the top of the heart and passes to the fast back bundle, like the retrograde knee.
2. Up to 10% of cases occur on the front fascicular ventricular tachycardia - the excitation wave circulation occurs in the same way as in the case of the rear LPH, only at the end of the task the retrograde knee performs the front sheath.
3. In rare cases, the upper-septal left ventricular tachycardia is detected - the development of this form of LHFT can pass with or without the involvement of the middle beam.
Very rarely interfacial left ventricular tachycardia can be detected. Its development is characterized by the involvement of both beams. The appearance of this form of LPHF is often associated with structural changes in the heart.
Diagnosis of left ventricular tachycardia
The disease is very similar to supraventricular tachycardia, so diagnosis is not easy. Monitoring of the specific properties of ventricular tachycardia helps to diagnose the condition:
- the presence of atrioventricular dissociation;
- determination of grips or drainage complexes.
Characteristic of ECG-signs characteristic of LHRF:
- In the back passage of the pathological pulse, the deviation of the axis of the heart to the left is observed, the ventricular complex morphologically similar to the blockage of the right leg of the beam of the Giassi, narrow or broader in width.
- At the front - the heart axis is deflected to the right, the ventricular complexes, as in the first form, are narrow or slightly enlarged, the blockade of the right leg of the Hyza bundle is determined.
- At the top - the axis of the heart is normal, the ventricular complexes are narrow, the blockade can be both the right and left legs of the bundle of Guillaume.
The response to treatment also helps determine the form of the disease. In the case of LHFT, lidocaine, adenosine, vagal tests are useless, whereas the administration of verapamil immediately brings the result. Also, when administering antibodies to digoxin, a digoxin-sensitive fascicular ventricular tachycardia may develop.
In diagnostics of pathology often uses Holter monitoring. With its help it is possible to fix an attack in the majority of patients, which, as noted, is often preceded by sinus tachycardia. In 95% of cases, BPH is facilitated by bicycle ergometry, which acts as a physical activity. As an diagnostic method, echocardiography is useful, in which patients with LPHT often identify additional components in the cavity of the left ventricle in the form of excess trabecula and false chords.
Treatment and prevention of left ventricular tachycardia
The appointment of antiarrhythmic therapy in patients with LPHF is often ineffective. Patients are often prescribed isoptin, cordarone, anaprilin, but the result of their introduction is observed only in a small percentage of cases.
Programming or accelerating stimulation of the right ventricle can be used to reduce the paroxysm of the left ventricular tachycardia.
The method of choice in the treatment of left ventricular tachycardia is radiofrequency ablation. This procedure is usually carried out on a planned basis. Before performing it, an electrophysiological study is required to induce ventricular or fascicular tachycardia. The mapping or moxibustion of LPHF is performed by retrograde access to the left ventricle through the aorta. Multiplan fluoroscope is used to control the location of the electrodes. After the ablation of the pathological focal point for the patient for some time, observation is carried out, and as experience shows, only 10% again develop attacks of tachycardia, which, after a repeated operation, almost completely disappear.
Specific prevention of left ventricular tachycardia does not exist today, so one should adhere to the general recommendations given to all cardiologic patients.