Posterior idiopathic fascicular ventricular tachycardia. A case report

Abstract

Idiopathic left ventricular fascicular tachycardias are a rare form of ventricular tachycardia. In general, they represent 10-15% of all idiopathic ventricular tachycardias, with verapamil being useful in their treatment and in the prevention of recurrences. They are typical of young males (15-40 years old) and although they usually occur at rest, they can be induced by catecholamines in situations of emotional stress or exercise. We present the case of a 40-year-old woman, 35 weeks 6 days pregnant, admitted to the emergency department of our center for the presence of palpitations and elevated heart rate in the context of emotional stress. She had been previously evaluated for similar symptomatology, which spontaneously remitted. The electrocardiogram showed repolarization alterations, incomplete right bundle branch block pattern, atrioventricular dissociation, and sustained tachycardia refractory to treatment, and it was decided to terminate the pregnancy due to signs of fetal distress. In the NICU hospitalization ward, the patient presented again with sustained ventricula tachycardia controlled by administration of verapamil and subsequent radiofrequency cardiac ablation by means of a navigator.