Ventricular outflow tract tachycardia

Most but not all forms of recurrent ventricular tachycardia occur in patients with extensive heart disease. Ventricular tachycardia occurring in a patient without heart disease is sometimes referred to as idiopathic ventricular tachycardia and may take several forms. " Fascicular tachycardia arises from a fascicle of the left bundle branch (usually posterior) and usually is not associated with severe underlying heart disease. Calcium channel blockers (but not adenosine) are effective in terminating an acute episode of fascicular ventricular tachycardia. Ventricular outflow tract tachycardia (usually originating from the right ventricular outflow tract and thus abbreviated RVOT) originates from near the pulmonic valve (or uncommonly the aortic) and also occurs in patients with normal LV without discernible cardiac disease. Unlike other forms of ventricular tachycardia, RVOT... 

Cole CR, Marrouche NF, Natale A. Evaluation and management of ventricular outflow tract tachycardias. Card Electrophysiol Rev 2002 6 442-447. 

Ablation of ventricular tachycardia with complete cure is possible for idiopathic right ventricular outflow tract tachycardia, for idiopathic left ventricular tachycardia from the apical septum, for ventricular tachycardia due to Tetralogy of Fallot, and for bundle branch reentrant tachycardias. Ablation can be effective for ventricular tachycardia with other associated structural heart disease, but no evidence indicates that it will decrease the risk of death. 

Fig. 4. 96 Right anterior oblique (RAO) (panel A) and left anterior oblique (LAO) (panel B) sections of the male heart obtained from the EPFL s visible human surface server, EPFL 1998. Panel A shows the inferior caval vein (ICV), the inferior isthmus (CTI), the supraventricular crest (SVC), the aorta (Ao), and right ventricular outflow tract (RVOT). The white dot signals the site corresponding to the membranous septum or the maximal His-Bundle potential is usually recorded. In the LAO projection, the right atrial appendage (RAA) and the right and left atria at the level of the atrial ventricular junction s are depicted. The white dot also signals the area were the his bundle is recorded. The left atrial appendage (LAA) is superior, (from Farre J, Anderson RH, Cabrera JA, et al Fluorscopic cardiac anatomy for catheter ablation of tachycardia. PACE 25 88, 2002)...

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