Research Article|Articles in Press

Progressive outcomes of bundle branch reentrant ventricular tachycardia in patients without structural heart disease


      Ablation strategies to treat bundle branch reentrant ventricular tachycardia (BBRT) are well described. However, reports of long-term follow-up outcomes in BBRT patients without structural heart disease (SHD) are limited.


      The purpose of this study was to investigate the long-term follow-up prognosis of BBRT patients without SHD.


      Changes in electrocardiographic and echocardiographic parameters were used to evaluate progression during follow-up. Potential pathogenic candidate variants were screened using a specific gene panel.


      Eleven consecutive BBRT patients without obvious SHD based on echocardiographic and cardiovascular magnetic resonance imaging results were enrolled. Median age was 20 (11–48) years, and median follow-up time was 72 months. During follow-up, PR interval [206 (158–360) ms vs 188 (158–300) ms; P = .018] and QRS duration [187 (155–240) ms vs 164 (130–178) ms; P = .008] each increased significantly compared with postablation. Right- and left-sided chamber dilation and reduced left ventricular ejection fraction (LVEF) also were observed. Clinical deterioration or events occurred in 8 patients: 1 sudden death; 3 both complete heart block and reduced LVEF; 2 significantly reduced LVEF; and 2 prolonged PR interval. Genetic testing results showed that 6 of 10 patients (excluding the patient with sudden death) had ≥1 potential pathogenic candidate variants.


      Further deterioration of His–Purkinje system conduction was observed in young BBRT patients without SHD after ablation. The His–Purkinje system may be the first target of genetic predisposition.

      Graphical abstract


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        • Caceres J.
        • Jazayeri M.
        • McKinnie J.
        • et al.
        Sustained bundle branch reentry as a mechanism of clinical tachycardia.
        Circulation. 1989; 79: 256-270
        • Blanck Z.
        • Dhala A.
        • Deshpande S.
        • Sra J.
        • Jazayeri M.
        • Akhtar M.
        Bundle branch reentrant ventricular tachycardia: cumulative experience in 48 patients.
        J Cardiovasc Electrophysiol. 1993; 4: 253-262
        • Mehdirad A.A.
        • Keim S.
        • Rist K.
        • Tchou P.
        Long-term clinical outcome of right bundle branch radiofrequency catheter ablation for treatment of bundle branch reentrant ventricular tachycardia.
        Pacing Clin Electrophysiol. 1995; 18: 2135-2143
        • Roberts J.D.
        • Gollob M.H.
        • Young C.
        • et al.
        Bundle branch re-entrant ventricular tachycardia: novel genetic mechanisms in a life-threatening arrhythmia.
        JACC Clin Electrophysiol. 2017; 3: 276-288
        • Chen H.
        • Shi L.
        • Yang B.
        • et al.
        Electrophysiological characteristics of bundle branch reentry ventricular tachycardia in patients without structural heart disease.
        Circ Arrhythm Electrophysiol. 2018; 11e006049
        • Cohen T.J.
        • Chien W.W.
        • Lurie K.G.
        • et al.
        Radiofrequency catheter ablation for treatment of bundle branch reentrant ventricular tachycardia: results and long-term follow-up.
        J Am Coll Cardiol. 1991; 18: 1767-1773
        • Lopera G.
        • Stevenson W.G.
        • Soejima K.
        • et al.
        Identification and ablation of three types of ventricular tachycardia involving the His-Purkinje system in patients with heart disease.
        J Cardiovasc Electrophysiol. 2004; 15: 52-58
        • Blanck Z.
        • Akhtar M.
        Ventricular tachycardia due to sustained bundle branch reentry: diagnostic and therapeutic considerations.
        Clin Cardiol. 1993; 16: 619-622
        • Akhtar M.
        • Gilbert C.
        • Wolf F.G.
        • Schmidt D.H.
        Reentry within the His-Purkinje system. Elucidation of reentrant circuit using right bundle branch and His bundle recordings.
        Circulation. 1978; 58: 295-304
        • Blanck Z.
        • Deshpande S.
        • Jazayeri M.R.
        • Akhtar M.
        Catheter ablation of the left bundle branch for the treatment of sustained bundle branch reentrant ventricular tachycardia.
        J Cardiovasc Electrophysiol. 1995; 6: 40-43
        • Berger R.D.
        • Orias D.
        • Kasper E.K.
        • Calkins H.
        Catheter ablation of coexistent bundle branch and interfascicular reentrant ventricular tachycardias.
        J Cardiovasc Electrophysiol. 1996; 7: 341-347
        • Negri S.M.
        • Cowan M.D.
        Becker muscular dystrophy with bundle branch reentry ventricular tachycardia.
        J Cardiovasc Electrophysiol. 1998; 9: 652-654
        • Takeda K.
        • Takemoto M.
        • Mukai Y.
        • et al.
        Bundle branch re-entry ventricular tachycardia in a patient with myotonic dystrophy.
        J Cardiol. 2009; 53: 463-466
        • Merino J.L.
        • Carmona J.R.
        • Fernandez-Lozano I.
        • Peinado R.
        • Basterra N.
        • Sobrino J.A.
        Mechanisms of sustained ventricular tachycardia in myotonic dystrophy: implications for catheter ablation.
        Circulation. 1998; 98: 541-546
        • Blanck Z.
        • Jazayeri M.
        • Dhala A.
        • Deshpande S.
        • Sra J.
        • Akhtar M.
        Bundle branch reentry: a mechanism of ventricular tachycardia in the absence of myocardial or valvular dysfunction.
        J Am Coll Cardiol. 1993; 22: 1718-1722
        • Priori S.G.
        • Blomström-Lundqvist C.
        • Mazzanti A.
        • et al.
        2015 ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: the Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC)Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC).
        Europace. 2015; 17: 1601-1687
        • Tchou P.
        • Jazayeri M.
        • Denker S.
        • Dongas J.
        • Caceres J.
        • Akhtar M.
        Transcatheter electrical ablation of right bundle branch. A method of treating macroreentrant ventricular tachycardia attributed to bundle branch reentry.
        Circulation. 1988; 78: 246-257
        • Schmidt B.
        • Tang M.
        • Chun K.R.
        • et al.
        Left bundle branch-Purkinje system in patients with bundle branch reentrant tachycardia: lessons from catheter ablation and electroanatomic mapping.
        Heart Rhythm. 2009; 6: 51-58
        • Li Y.G.
        • Grönefeld G.
        • Israel C.
        • Bogun F.
        • Hohnloser S.H.
        Bundle branch reentrant tachycardia in patients with apparent normal His-Purkinje conduction: the role of functional conduction impairment.
        J Cardiovasc Electrophysiol. 2002; 13: 1233-1239
        • Merino J.L.
        • Peinado R.
        • Fernandez-Lozano I.
        • et al.
        Bundle-branch reentry and the postpacing interval after entrainment by right ventricular apex stimulation: a new approach to elucidate the mechanism of wide-QRS-complex tachycardia with atrioventricular dissociation.
        Circulation. 2001; 103: 1102-1108
        • Yao X.P.
        • Cheng X.
        • Wang C.
        • et al.
        Biallelic mutations in MYORG cause autosomal recessive primary familial brain calcification.
        Neuron. 2018; 98: 1116-1123.e1115
        • Richards S.
        • Aziz N.
        • Bale S.
        • et al.
        Standards and guidelines for the interpretation of sequence variants: a joint consensus recommendation of the American College of Medical Genetics and Genomics and the Association for Molecular Pathology.
        Genet Med. 2015; 17: 405-424
        • Pathak R.K.
        • Fahed J.
        • Santangeli P.
        • et al.
        Long-term outcome of catheter ablation for treatment of bundle branch re-entrant tachycardia.
        JACC Clin Electrophysiol. 2018; 4: 331-338
        • Sarkozy A.
        • Boussy T.
        • Chierchia G.B.
        • Geelen P.
        • Brugada P.
        An unusual form of bundle branch reentrant tachycardia.
        J Cardiovasc Electrophysiol. 2006; 17: 902-906
        • Kusa S.
        • Taniguchi H.
        • Hachiya H.
        • et al.
        Bundle branch reentrant ventricular tachycardia with wide and narrow QRS morphology.
        Circ Arrhythm Electrophysiol. 2013; 6: e87-e91
        • Matsuoka K.
        • Fujii E.
        • Uchida F.
        Successful radiofrequency catheter ablation of "clockwise" and "counterclockwise" bundle branch re-entrant ventricular tachycardia in the absence of myocardial or valvar dysfunction without detecting bundle branch potentials.
        Heart. 2003; 89: e12
        • Groh W.J.
        • Bhakta D.
        • Tomaselli G.F.
        • et al.
        2022 HRS expert consensus statement on evaluation and management of arrhythmic risk in neuromuscular disorders.
        Heart Rhythm. 2022; 19: e61-e120