Abstract
Ablation of sites showing Purkinje activity is antiarrhythmic in some patients with idiopathic ventricular fibrillation (iVF). The mechanism for the therapeutic success of ablation is not fully understood. We propose that deeper penetrance of the Purkinje network allows faster activation of the ventricles and is proarrhythmic in the presence of steep repolarization gradients. Reduction of Purkinje penetrance, or its indirect reducing effect on apparent propagation velocity may be a therapeutic target in patients with iVF.
Highlights
Patients who have survived idiopathic ventricular fibrillation are typically difficult to treat and often rely on an implanted Cardioverter Defibrillator (ICD) to restore normal heart rhythm (Patton et al, 2016)
We reasoned that a Purkinje system that extends slightly more into the walls of the ventricles leads to a shorter QRS “body” (QRS50, QRS duration at 50% of the QRS amplitude)
Our simulations indicate that a deeper penetrating Purkinje network is associated with a short QRS50 and a J-wave (ER pattern) as an expression of relatively late activated tissue
Summary
Patients who have survived idiopathic ventricular fibrillation (iVF) are typically difficult to treat and often rely on an implanted Cardioverter Defibrillator (ICD) to restore normal heart rhythm (Patton et al, 2016). When the Purkinje network extended 5 mm into the left ventricular wall, the QRS complex became shorter especially at mid-amplitude and was followed by J-waves similar to those in patients with the Early Repolarization pattern. Our simulations indicate that a deeper penetrating Purkinje network is associated with a short QRS50 and a J-wave (ER pattern) as an expression of relatively late activated tissue. This generates the question whether humans with a short QRS50 are more at risk for idiopathic ventricular re-entrant arrhythmias (Wolpert et al, 2008).
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