ヒグチ　サトシ   HIGUCHI Satoshi   樋口　諭    所属   医学部 医学科（東京女子医科大学病院）    職種   寄附部門講師
論文種別	原著
言語種別	英語
査読の有無	査読あり
表題	The Role of the Left Septal Fascicle in Fascicular Arrhythmias: Clinical Presentation and Laboratory Evaluation.
掲載誌名	正式名：JACC. Clinical electrophysiology 略　 称：JACC Clin Electrophysiol ISSNコード：24055018/2405500X
掲載区分	国外
巻・号・頁	7(7),pp.858-870
著者・共著者	Sanchez JosM, Higuchi Satoshi†, Walters Tomos E, Vedantham Vasanth, Hsia Henry, Gerstenfeld Edward P, Badhwar Nitish, Albona Mariana, Njeim Mario, Scheinman Melvin M
発行年月	2021/07
概要	OBJECTIVES:This study describes a series of cases best explained by invoking the left septal fascicle (LSF) as a critical component of the arrhythmia circuit.BACKGROUND:Numerous anatomic studies have shown evidence of the LSF, but its precise role in the onset of arrhythmia is unclear.METHODS:This paper presents 5 cases that implicated the LSF as a critical component of arrhythmogenesis.RESULTS:The first case had ventricular fibrillation repeatedly documented after a single premature atrial complex, produced left-sided conduction delay and simultaneous earliest activation of the left anterior fascicle (LAF) and left posterior fascicle (LPF). The LSF was ablated, resulting in an arrhythmia cure. The second case showed narrow QRS morphology during fascicular re-entrant tachycardia. The earliest mid-septal diastolic potentials had distal-to-proximal activation suggesting an LSF as a retrograde common pathway. The third case, with multiple ectopic Purkinje-related premature complexes exhibited earliest Purkinje potentials in the mid-septum, with subsequent anterograde activation of the LAF and LPF. Ablation of the LSF eliminated the premature ventricular complexes (PVCs). The fourth case demonstrated LPF and LAF PVCs. The His-left bundle activation showed earliest potentials at the proximal insertion of the left bundle during LPF PVCs, as well as a distal-to-proximal activation pattern during LAF PVC, suggestive of LSF involvement. The fifth case had focal non-re-entrant fascicular beats successfully ablated over the LSF.CONCLUSIONS:Involvement of the LSF is suspected with presentation of multiform fascicular and narrow QRS complex ventricular episodes of arrhythmia. Diagnoses and ablation require detailed mapping of the entire left sided conduction system.
DOI	10.1016/j.jacep.2020.12.012
PMID	33640350