Sustained ventricular fibrillation was characterized by significantly greater rotor stability than self-limiting episodes, with rotors present in 68% vs 11% of cycles (p<0.001).
Observational (n=26)
Does rotor stability differentiate sustained ventricular fibrillation from self-terminating episodes in humans?
The formation of stable rotors distinguishes sustained ventricular fibrillation requiring defibrillation from self-terminating episodes.
Absolute Event Rate: 68% vs 11%
p-value: p=<0.001
Objective We mapped human ventricular fibrillation (VF) to define mechanistic differences between episodes requiring defibrillation versus those that spontaneously terminate. Background VF is a leading cause of mortality, yet episodes may also self-terminate. We hypothesized that the initial maintenance of human VF is dependent upon the formation and stability of VF rotors. Methods We enrolled 26 consecutive patients (age 64±10 years, n=13 with LV dysfunction) during ablation procedures for ventricular arrhythmias, using 64-electrode basket catheters in both ventricles to map VF prior to prompt defibrillation per IRB-approved protocol. Fifty-two inductions were attempted and 36 VF episodes were observed. Phase analysis was applied to identify bi-ventricular rotors in the first 10 seconds or until VF terminated, whichever came first (11.4±2.9 seconds to defibrillator charging). Results Rotors were present in 16 of 19 patients with VF, and in all patients with sustained VF. Sustained, but not self-limiting VF, was characterized by greater rotor stability: (1) rotors were present in 68±17% of cycles in sustained versus 11±18% of cycles in self-limiting VF (p<0.001); with (2) maximum continuous rotations greater in sustained (17±11, range 7–48) versus self-limiting VF (1.1±1.4, range 0–4, p<0.001). Additionally, biventricular rotor locations in sustained VF were conserved across multiple inductions (7/7 patients, p=0.025). Conclusions In patients with and without structural heart disease, the formation of stable rotors identifies individuals whose VF requires defibrillation from those in whom VF spontaneously self-terminates. Future work should define the mechanisms that stabilize rotors and evaluate whether rotor modulation may reduce subsequent VF risk.
“If the results are validated by larger multicentre studies, it could potentially represent a paradigm shift in mapping and treatment of VF. Until then, treatment of underlying heart disease, ICDs, antiarrhythmic drugs and ablation of triggers are the cornerstone for management of recurrent VF.”
Krummen et al. (Wed,) conducted a observational in Ventricular fibrillation (n=26). Sustained ventricular fibrillation vs. Self-limiting ventricular fibrillation was evaluated on Percentage of cycles with rotors present (p=<0.001). Sustained ventricular fibrillation was characterized by significantly greater rotor stability than self-limiting episodes, with rotors present in 68% vs 11% of cycles (p<0.001).