Idiopathic Right Ventricular Outflow Tract Tachycardia: Which Substrate, Mechanism and Therapy?

  • A. Proclemer
  • C. Fresco


Ventricular tachycardias (VT) may occur in patients who have no clear evidence of organic heart disease. So-called idiopathic VT accounts for 12%–17% of all cases of VT [1, 2]. In approximately 70%–80% of cases idiopathic VT originates from the right ventricular outflow tract (RVOT) and the ECG aspect is characterized by left bundle branch block (LBBB) and inferior axis (IA) morphology [2, 3]. Idiopathic RVOT-VT presents two main clinical forms: (1) repetitive monomorphic VT, and (2) paroxysmal stress-mediated sustained VT. The first arrhythmic pattern includes repetitive ectopies and paroxysms of nonsustained VT with the same morphology, the second is typically characterized by episodes of VT induced by stress, exercise or catecholamine infusion. Some patients can have either form of RVOT-VT, and during exercise stress testing they show initial suppression of nonsustained VT, final induction of sustained VT or relapse of the arrhythmia immediately after the peak exercise. Finally, a third form of the RVOT arrhythmic syndrome includes frequent and/or repetitive monomorphic (LBBBIA) ventricular premature beats without sustained VT episodes.


Ventricular Tachycardia Right Ventricle Left Bundle Branch Block Right Ventricular Outflow Tract Radiofrequency Catheter Ablation 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Brooks R, Burgess JH (1988) Idiopathic ventricular tachycardia: a review. Medicine 67: 271–294PubMedCrossRefGoogle Scholar
  2. 2.
    Proclemer A, Facchin D, Miani D, Feruglio GA (1994) Tachicardia e fibrillazione ventricolare idiopatiche. Inquadramento, diagnosi, terapia e prognosi. G Ital Cardiol 24: 1027–1041PubMedGoogle Scholar
  3. 3.
    Lerman BB, Stein KM, Markowitz SM (1996) Idiopathic right ventricular outflow tract tachycardia: a clinical approach. PACE 19: 2120–2137PubMedCrossRefGoogle Scholar
  4. 4.
    Rahilly GI, Prystovsky EN, Zipes DP, Naccarelli GV, Jackman WM, Heger JJ (1982) Clinical and electrophysiological findings in patients with repetitive monomorphic ventricular tachycardia and otherwise normal electrocardiogram. Am J Cardiol 50: 459–468PubMedCrossRefGoogle Scholar
  5. 5.
    Martini B, Nava A, Thiene G et al (1988) Accelerated idioventricular rhythm of infundibular origin in patients with a concealed form of arrhythmogenic right ventricular dysplasia. Br Heart J 59: 564–571PubMedCrossRefGoogle Scholar
  6. 6.
    Carlson MD, White RD, Trohman RG, Adler LP, Biblo LA, Merkatz KA, Waldo AL (1994) Right ventricular outflow tract ventricular tachycardia: detection of previously unrecognized anatomic abnormalities using cine magnetic resonance imaging. J Am Coll Cardiol 24: 720–727PubMedCrossRefGoogle Scholar
  7. 7.
    Buxton AE, Waxman HL, Marchlinski FE, Simson MB, Cassidy D, Josephson ME (1983) Right ventricular tachycardia: clinical and electrophysiological characteristics. Circulation 68: 917–927PubMedCrossRefGoogle Scholar
  8. 8.
    Proclemer A, Ciani R, Feruglio GA (1989) Right ventricular tachycardia with left bundle branch block and inferior axis morphology. Clinical and arrhythmological characteristics in 15 patients. PACE 12: 977–989PubMedCrossRefGoogle Scholar
  9. 9.
    Mont L, Seixas T, Brugada P et al (1992) The electrocardiographic, clinical and electrophysiologic spectrum of idiopathic monomorphic ventricular tachycardia. Am Heart J 124: 746–753PubMedCrossRefGoogle Scholar
  10. 10.
    Lerman BB, Stein K, Engelstein ED et al (1995) Mechanism of repetitive monomorphic ventricular tachycardia. Circulation 92: 421–429PubMedCrossRefGoogle Scholar
  11. 11.
    Globits S, Kreiner G, Heinz G, Frank H, Klaar U, Gossinger H (1995) Morphologic abnormalities by magnetic resonance imaging in relation to successful ablation sites in right ventricular outflow tract tachycardia. Circulation 92: 1–684CrossRefGoogle Scholar
  12. 12.
    Gill JS, Rowland E, de Belder M, Rees S, Ward DE, Underwood R, Camm AJ (1993) Cardiac abnormalities not visualised by echocardiography and angiography are detected by magnetic resonance imaging in patients with idiopathic ventricular tachycardia. Eur Heart J 14: (suppl) 7CrossRefGoogle Scholar
  13. 13.
    Proclemer A, Basadonna PT, Slavich GA, Miani D, Fresco C, Fioretti PM (1997) Cardiac magnetic resonance imaging findings in patients with right ventricular outflow tract premature contractions. Eur Heart J (in press)Google Scholar
  14. 14.
    Gursoy S, Brugada J, Souza O, Steurer G, Andries E, Brugada P (1992) Radiofrequency ablation of symptomatic but benign ventricular arrhythmias. PACE 15: 738–741PubMedCrossRefGoogle Scholar
  15. 15.
    Gumbrielle T, Bourke JP, Furniss SS (1994) Is ventricular ectopy a legitimate target for ablation?. Br Heart 72: 492–494CrossRefGoogle Scholar
  16. 16.
    Zhu DW, Maloney JD, Simmons TW et al (1995) Radiofrequency catheter ablation for management of symptomatic ventricular ectopic activity. J Am Coll Cardiol 26: 843–849PubMedCrossRefGoogle Scholar
  17. 17.
    Wilber DJ, Baerman J, Olshansky B, Kall J, Kopp D (1993) Adenosine-sensitive ventricular tachycardia. Clinical characteristics and response to catheter ablation. Circulation 87: 126–134Google Scholar
  18. 18.
    Klein LS, Shih HT, Hackett FK, Zipes DP, Miles WM (1992) Radiofrequency catheter ablation of ventricular tachycardia in patients without structural heart disease. Circulation 85: 1666–1674PubMedCrossRefGoogle Scholar
  19. 19.
    Coggins DL, Lee RJ, Sweeney J et al (1994) Radiofrequency catheter ablation as a cure for idiopathic tachycardia of both left and right ventricular origin. J Am Coll Cardiol 23: 1333–1341PubMedCrossRefGoogle Scholar
  20. 20.
    Mowsowitz C, Schwartzman D, Callans DJ et al (1996) Idiopathic right ventricular outflow tract tachycardia: narrowing the anatomic location for successful ablation. Am Heart J 131: 930–936CrossRefGoogle Scholar
  21. 21.
    De Roy L, Blommaert D, Conad O, Jamart J (1996) Ablation of idiopathic ventricular arrhythmias. Short term and long term results. In: M. Santini (ed) Progress of clinical pacing. Futura Armonk, New York, pp 413–420Google Scholar
  22. 22.
    Chinushi M, Aizawa Y, Takahashi K et al (1997) Morphological variation of nonreentrant idiopathic ventricular tachicardias originating from the right ventricular outflow tract and effect of radiofrequency lesion. PACE 20: 325–336PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 1998

Authors and Affiliations

  • A. Proclemer
    • 1
  • C. Fresco
    • 1
  1. 1.Istituto di CardiologiaAzienda Ospedaliera Santa Maria della MisericordiaUdineItaly

Personalised recommendations