Key result
Catheter ablation of Purkinje-mediated PVCs from the RV moderator band effectively prevents recurrent idiopathic VF.
Why the study?
The moderator band is increasingly recognized as a source of Purkinje-mediated ventricular arrhythmias and idiopathic VF in the absence of structural heart disease, but arrhythmogenic mechanisms remain debated.
Does catheter-based ablation effectively manage arrhythmias originating from the right ventricular moderator band?
Does catheter-based ablation effectively manage arrhythmias originating from the right ventricular moderator band?
Recognition of typical PVC morphology can identify the right ventricular moderator band as a source of idiopathic VF, offering an opportunity for effective treatment with catheter ablation.
May support ablation of moderator band Purkinje PVCs to prevent recurrent idiopathic VF; extends observational data but prospective trials needed.
The moderator band in the right ventricle is being increasingly recognised as a source for arrhythmias in the absence of identifiable structural heart disease. Because it carries part of the conduction system from the right ventricle septum to the free wall, it is a source of Purkinje-mediated ventricular arrhythmias that manifest as premature ventricular contractions (PVC) or repetitive ventricular tachycardia. More importantly, short coupled PVCs triggering polymorphic ventricular tachycardia and VF have been localised to the moderator band and ablation of these Purkinje mediated PVCs can effectively prevent recurrent VF. The exact mechanism of arrhythmogenesis is still debated but stretch, fibrosis and ion channel alterations might be responsible. Arrhythmias originating in this region of the right ventricle may thus be another cause for idiopathic VF that is potentially treatable with catheter-based ablation techniques. Recognition of the typical PVC morphology can point to the moderator band as the source of idiopathic VF and an opportunity for timely intervention. The available data on the anatomy, electrophysiology and management options are reviewed.
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Barber et al. (2020) conducted a review in Arrhythmias from the Right Ventricular Moderator Band. Catheter-based ablation was evaluated. Catheter-based ablation of Purkinje-mediated premature ventricular contractions from the right ventricular moderator band can effectively prevent recurrent idiopathic ventricular fibrillation.
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