Treatment-Resistant Fascicular Ventricular Tachycardia: A Case Report

TL;DR

A young male with treatment-resistant fascicular ventricular tachycardia was successfully treated with catheter ablation after ineffective medical therapy.

Contribution

This case report highlights the successful use of catheter ablation in a treatment-resistant fascicular VT case misdiagnosed for years.

Findings

The patient experienced long-term misdiagnosis before posterior fascicular VT was identified.

Medical therapy with verapamil was ineffective, but catheter ablation provided a good outcome.

Fascicular VT can mimic supraventricular tachycardia due to narrow QRS complexes.

Abstract

Fascicular ventricular tachycardia (VT) is a form of VT that arises through a re-entrant pathway utilising the Purkinje fibres. It can be categorised based on the anatomical origin of the re-entrant pathway. Fascicular VT typically affects young males. We present a case of a young male patient with treatment-resistant fascicular VT. A young male in his twenties spent much of his adolescence (8 years) suffering from sudden-onset and offset ‘panic attack’-like symptoms. A routine preoperative ECG showed posterior fascicular VT. After a poor response to medical therapy, the patient underwent two catheter ablation procedures, with a final good symptomatic outcome. Fascicular VT is often difficult to diagnose and can be misinterpreted as supraventricular tachycardia (SVT) given the narrow QRS. The mainstay of medical management is verapamil; however, more invasive treatments such as catheter ablation are available, yielding high success rates.

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