What Is the Real Identity of the Mysterious Potential P1 and What Is the Most Important Segment of the Fascicular Ventricular Tachycardia Circuit?

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In 1845, Johannes Evangelista Purkinje (Purkyně) discovered gelatinous fibers in the ventricular subendocardium. Later, they were called Purkinje fibers.1 However, he could not determine the function of that strange tissue and thought it was muscular. In 1906, Sunao Tawara finally described its function as the conducting system (Figure).2 In the last 3 decades, there has been rapid progress in the treatment of ventricular arrhythmias, and the Purkinje system has been found to be responsible for the mechanism of some ventricular tachyarrhythmias. These ventricular tachyarrhythmias can be called Purkinje-related arrhythmias and are manifested as monomorphic ventricular tachycardia (VT) and polymorphic VT, including ventricular fibrillation. Figure. A macroscopic image of the left ventricle of the human heart. The anterior wall of the left ventricle was cut from just below the aortic valve to the cardiac apex at the line between the anterior and posterior papillary muscles and opened toward the right and left. Major and small papillary muscles, fibromuscular bands, and connecting tendons are seen ( top ). The entire course of the left bundle branch and its terminal ramifications are illustrated in red ink on the tracing paper ( bottom ). Adapted from Tawara2 with permission of the publisher. Copyright © 1906, Scientific Publishing Europe, Ltd. Authorization for this adaptation has been obtained both from the owner of the copyright in the original work and from the owner of copyright in the translation or adaptation. See Article by Liu et al The most common form of idiopathic left ventricular (LV) tachycardia is verapamil-sensitive fascicular tachycardia.3–9 The underlying mechanism of this tachycardia has been extensively investigated since Zipes et al3 first recognized the phenomenon in 1979. The mechanism of this VT is reentry because it can be induced, entrained, and terminated by ventricular or atrial stimulation. Many investigators hypothesized …

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