Key result
Purkinje fiber ablation terminates prolonged ventricular fibrillation in ~80% of canine models.
Why the study?
Does subendocardial ablation of Purkinje fibers with Lugol's solution alter the activation rate and maintenance of long-duration ventricular fibrillation in an in vivo canine model?
Does subendocardial ablation of Purkinje fibers with Lugol's solution alter the activation rate and maintenance of long-duration ventricular fibrillation in an in vivo canine model?
Subendocardial ablation of Purkinje fibers significantly reduces the activation rate and promotes early spontaneous termination of long-duration ventricular fibrillation in an in vivo canine model, suggesting Purkinje fibers play a crucial role in LDVF maintenance.
Answers are grounded in this paper and cite their sources.
Should not alter clinical VF management; supports Purkinje role in sustaining VF and leaves translation to humans open.
AIM: To determine the role of repetitive endocardial focal activations and Purkinje fibers in the maintenance of long duration ventricular fibrillation (LDVF, VF>1 minute) in canine hearts in vivo. METHODS: The study was conducted in electrophysiological laboratory of Shanghai Ruijin hospital from July 2010 to August 2012. A 64-electrode basket was introduced through a carotid artery into the left ventricle (LV) of 11 beagle dogs for global endocardial electrical mapping. In the Lugol's solution group (n=5), the subendocardium was ablated by washing with Lugol's solution. In the control group, (n=6) saline was used for ablation. Before and after saline or Lugol ablation, we determined QRS duration and QT/QTc interval in sinus rhythm (SR). We also measured the activation rates in the first 2 seconds of each minute during 7 minutes of VF for each group. If VF terminated spontaneously in less than 7 minutes, the VF segments used in activation rate analysis were reduced accordingly. RESULTS: At the beginning of VF there was no difference between the groups in the activation rate. However, after 1 minute of LDVF the Lugol's solution group had significantly slower activation rate than the control group. In the control group, all episodes of LDVF (6/6) were successfully sustained for 7 minutes, while in the Lugol's solution group 4/5 episodes of LDVF spontaneously terminated before 7 minutes (4.8±1.4 minutes) (P=0.015). In the control group, at 5.1±1.3 minutes of LDVF, a successive, highly organized focal LV endocardial activation pattern was observed. During this period, activations partly arose in PF and spread to the working ventricular myocardium. Mapping analysis showed that these events were consistent with repetitive endocardial focal activations. No evidence of similar focal activations was observed in the Lugol's solution group. CONCLUSIONS: Repetitive endocardial focal activations in the LV endocardium may be associated with activation of subendocardial PFs. This mechanism may play an important role in the maintenance of LDVF.
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Lin et al. (2014) studied Long duration ventricular fibrillation (n=11). Lugol's solution subendocardial ablation vs. Saline flush was evaluated on Spontaneous termination of long duration ventricular fibrillation before 7 minutes (p=0.015). Subendocardial ablation of Purkinje fibers with Lugol's solution caused spontaneous termination of long duration ventricular fibrillation before 7 minutes in 80% of dogs compared to 0% of controls.
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