{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,7]],"date-time":"2026-11-07T16:33:24Z","timestamp":1794069204542,"version":"4.8.0"},"reference-count":57,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2011,3,16]],"date-time":"2011-03-16T00:00:00Z","timestamp":1300233600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pacing Clinical Electrophis"],"published-print":{"date-parts":[[2011,5]]},"abstract":"<jats:p> <jats:italic>Purkinje\u2010related monomorphic ventricular tachycardias (VTs) can be classified into four distinct groups: (1) verapamil\u2010sensitive left fascicular VT, (2) Purkinje fiber\u2010mediated VT post infarction, (3) bundle branch reentry (BBR) and interfascicular reentry VTs, and (4) focal Purkinje VT. There are three subtypes of fascicular VTs: (1) left posterior fascicular VT with a right bundle branch block (RBBB) configuration and superior axis; (2) left anterior fascicular VT with an RBBB configuration and right\u2010axis deviation; and (3) upper septal fascicular VT with a narrow QRS configuration. The mechanism of the fascicular VT is macroreentry. While the antegrade limb of the circuit is a midseptal abnormal Purkinje fiber in the anterior and posterior fascicular VTs, the antegrade limb of the upper septal fascicular VT is both the anterior and posterior fascicles, and the retrograde limb is a midseptal abnormal Purkinje fiber. Purkinje fiber\u2010mediated VT post infarction also exhibits verapamil sensitivity, and the surviving muscle bundles within the myocardium and Purkinje system are components of the reentry circuit. BBR\u2010VT and interfascicular reentry VT are amenable to being cured by the creation of bundle or fascicular block. The mechanism of focal Purkinje VT is abnormal automaticity from the distal Purkinje system, and the ablation target is the earliest Purkinje activation during the VT. It is difficult to distinguish verapamil\u2010sensitive fascicular VT from focal Purkinje VT by the 12\u2010lead electrocardiogram; however, focal Purkinje VT is not responsive to verapamil<\/jats:italic>\n          <jats:italic>. The recognition of the heterogeneity of these VTs and their unique characteristics should facilitate an appropriate diagnosis and therapy. 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