MCQ 16.04.2015

All of the following arrhythmias are usually seen in structurally normal heart except

A. Right ventricular outflow tract ventricular tachycardia

B. Fascicular reentry ventricular tachycardia

C. Bundle branch reentry ventricular tachycardia

D. Catecholaminergic polymorphic ventricular tachycardia

 

Explanation:

Bundle branch reentry (BBR) ventricular tachycardia (VT) is a unique, fast (200 to 300 beats/min), monomorphic tachycardia associated with hemodynamic collapse, syncope, and/or cardiac arrest.

It is caused by a macroreentry circuit involving the right and left bundle branches, an upper common pathway, and septal ventricular muscle.

BBRoccurs in patients who have dilated cardiomyopathy and in those with coronary artery disease, valvular heart disease, myotonic dystrophy, or even no heart disease with associated His-Purkinje system disease.

The incidence is reported to be 3.5% and 6% of ventricular tachycardias

Classification of ventricular arrhythmias in the absence of structural heart disease

I. Non–life-threatening (typically monomorphic)
A. Outflow tract
Right ventricular outflow
Left ventricular outflow
Aortic sinus of Valsalva
Peri His bundle
B. Idiopathic left ventricular tachycardia
Left posterior fascicle
Left anterior fascicle
High septal fascicle
C. Other
Mitral annulus
Tricuspid annulus
Papillary muscle
Perivascular epicardial
II. Life-threatening (typically polymorphic)
A. Genetic syndromes
Long QT
Brugada
Catecholaminergic polymorphic ventricular tachycardia
Short QT
B. Idiopathic ventricular fibrillation

Answer: C

Ref:

1. Blanck Z, Dhala A, Deshpande S, et al: Bundle branch reentrant ventricular tachycardia: Cumulative experience in 48 patients. J Cardiovasc Electrophysiol 4:253–262, 1993.

2 . Blanck Z, Jazayeri M, Dhala A, et al: Bundle branch reentry: A mechanism of ventricular tachycardia in the absence of myocardial or valvular dysfunction. J Am Coll Cardiol 22:1718–1722, 1993.

3. Eric N. Prystowsky, Benzy J. Padanilam, Sandeep Joshi,  Richard I. Fogel. Ventricular Arrhythmias in the Absence of Structural Heart Disease. J Am Coll Cardiol 2012;59:1733–44

Keywords: Cardiology review, Cardiology, Multiple choice questions, medical students, Electrophysiology, Ventricular tachycardia

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