Abstract

Monomorphic ventricular premature beats (VPB) originating from the Purkinje network can induce polymorphic ventricular tachycardia (PMVT) and ventricular fibrillation (VF) storm. We hereby report the results of targeted ablation to treat PMVT/VF storms initiated by monomorphic VPB in seven patients with structural heart disease and left ventricular (LV)-dysfunction (n=4 withcoronary artery disease (CAD), n=2 with chronic and remote myocarditis, n=1 after aortic valve replacement). Pace-mapping and activation mapping was used to identify optimal ablation targets. Earliest activation during mapping was found midseptal of LV in three patients, midinferoseptal of LV in two patients. One patient with myocarditis showed earliest activation at free wall of right ventricle, the other one basal midseptal of LV. Local ventricular electrograms at the successful ablation sites were preceded by short, high frequency, low amplitude potentials by 22-90 ms (median 35 ms). The same local potentials were seen in sinus rhythm. Cycle lengths of VT ranged between 200 and 360 ms (median 245 ms). A median of nine radiofrequency (RF)-ablations (range 3-19) were necessary to abolish all local Purkinje potentials at the site of earliest activation. Two patients with CAD died due to refractory heart failure. The other five patients had no recurrence of PMVT and VF during follow up (median 10 months, range 1-27 months). The distal Purkinje network plays an important role in triggering PMVT/VF in patients with structural heart disease. Ablation of the triggering VPB originating from the Purkinje arborization is feasible; prevents recurrence in a long-term follow up; and is potentially life saving in patients with severe LV-dysfunction after myocardial infarction, in patients after aortic valve replacement, or in patients with myocarditis particularly when medical treatment, including antiarrhythmic drugs, failed to suppress electrical storms.

Full Text

Published Version

Talk to us

Join us for a 30 min session where you can share your feedback and ask us any queries you have

Schedule a call

Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.