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Cycle length oscillation during ventricular tachycardia: What is the mechanism?

  • Naohiko Sahara
    Affiliations
    The University of Arizona College of Medicine Phoenix, Phoenix, Arizona and Division of Cardiology, Banner – University Medical Center Phoenix, Phoenix, Arizona
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  • Roderick Tung
    Correspondence
    Address reprint requests and correspondence: Dr Roderick Tung, The University of Arizona College of Medicine – Phoenix, 755 E McDowell Rd, Phoenix, AZ 85006.
    Affiliations
    The University of Arizona College of Medicine Phoenix, Phoenix, Arizona and Division of Cardiology, Banner – University Medical Center Phoenix, Phoenix, Arizona
    Search for articles by this author
Published:January 27, 2023DOI:https://doi.org/10.1016/j.hrthm.2023.01.026
      A 55 year-old man with a history of inferoapical myocardial infarction presented with symptomatic tolerated ventricular tachycardia (VT) and was referred for catheter ablation. A linear tridecapolar catheter (1-1-1 mm, T3, Access Point Technologies, Rogers, MN) was positioned along the region of endocardial isochronal crowding on the isochronal late activation map. Stable monomorphic VT with right bundle branch superior axis with V4 transition was induced and exhibited spontaneous variability in tachycardia cycle length (TCL; 360–415 ms). What is the mechanism of oscillation in TCL? (Figure 1)
      Figure thumbnail gr1
      Figure 1Surface and intracardiac electrograms of selected electrodes with sweep speed 200 m/s during monomorphic ventricular tachycardia. The labeled RR intervals show spontaneous tachycardia cycle length variation. The local ventricular activation coincident with QRS breakout (V1–V6) on the LV 11-12 electrodes is numbered in sequence. The lower panel shows all local electrograms recorded from the LV 11-12 electrodes aligned vertically and scaled up for each respective cycle length.

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