Key result
Radiofrequency ablation targeting the Purkinje network achieves 100% acute procedural success with rare VF recurrence.
Why the study?
Ventricular fibrillation remains a fatal complication after successful PCI for STEMI, and clinical data on radiofrequency catheter ablation targeting the Purkinje network and septal substrate remain limited.
Does urgent radiofrequency catheter ablation targeting the Purkinje network and septal substrate improve arrhythmia control and survival in STEMI patients with therapy-refractory VF?
Cohort (n=13)
Yes
Does urgent radiofrequency catheter ablation targeting the Purkinje network and septal substrate improve arrhythmia control and survival in STEMI patients with therapy-refractory VF?
Purkinje-targeted septal substrate modification via RFCA is highly effective for acute arrhythmia control and long-term prevention of VF recurrence in STEMI patients with drug-refractory VF storm.
Supports feasibility of Purkinje-targeted ablation in STEMI VF storm; leaves open survival benefit and requires randomized confirmation.
BACKGROUND: Ventricular fibrillation (VF) remains a fatal complication after successful percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI). Radiofrequency catheter ablation (RFCA) targeting the Purkinje network and septal substrate shows promise, but clinical data remain limited. OBJECTIVE: This study aimed to evaluate the acute and long-term outcomes of RFCA targeting the Purkinje network and septal substrate in patients with STEMI with therapy-refractory VF after successful PCI. METHODS: Prospective, multicenter cohort of 13 consecutive patients with STEMI with drug-refractory VF storm despite successful PCI. VF occurred a median of 8 days after STEMI [interquartile range 6-13.5]. All underwent urgent RFCA with high-density left ventricular mapping and Purkinje-targeted septal substrate modification, aiming to eliminate spontaneous VF and achieve acute noninducibility during programmed stimulation. RESULTS: The left anterior descending artery was the predominant culprit vessel, identified in 12 of 13 cases (92.3%). Acute procedural success was achieved in all patients (100%). VF recurrence occurred in 1 of 13 (7.7%) during a median 21-month follow-up [interquartile range 14.5-47] and was successfully treated with repeat ablation. Procedure-related complete atrioventricular block occurred in 2 of 13 (15.4%). In-hospital mortality was 2 of 13 (15.4%), owing to stroke and sepsis. CONCLUSION: Septal substrate modification targeting the Purkinje network in STEMI patients with therapy-refractory VF-particularly after left anterior descending artery STEMI-may represent an effective therapeutic strategy for arrhythmia control and improved long-term survival. Further studies are needed to confirm these findings.
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Khalaph et al. (2025) conducted a cohort in STEMI with therapy-refractory ventricular fibrillation after successful PCI (n=13). Radiofrequency catheter ablation targeting the Purkinje network and septal substrate was evaluated on Acute procedural success (elimination of spontaneous VF and acute noninducibility). Radiofrequency catheter ablation targeting the Purkinje network and septal substrate achieved acute procedural success in 100% of patients, with 7.7% experiencing VF recurrence over 21 months.
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