Treatment-Resistant Fascicular Ventricular Tachycardia: A Case Report

Fascicular ventricular tachycardia (VT) is a form of VT that arises through a re-entrant pathway utilising the Purkinje fibres. It can be categorised based on the anatomical origin of the re-entrant pathway. Fascicular VT typically affects young males. We present a case of a young male patient with treatment-resistant fascicular VT. A young male in his twenties spent much of his adolescence (8 years) suffering from sudden-onset and offset 'panic attack'-like symptoms. A routine preoperative ECG showed posterior fascicular VT. After a poor response to medical therapy, the patient underwent two catheter ablation procedures, with a final good symptomatic outcome. Fascicular VT is often difficult to diagnose and can be misinterpreted as supraventricular tachycardia (SVT) given the narrow QRS. The mainstay of medical management is verapamil; however, more invasive treatments such as catheter ablation are available, yielding high success rates.