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February 8, 2021Circulation Arrhythmia and ElectrophysiologyOpen Access

Freedom from the primary outcome was 83% in the VF ablation group versus 17% in 6 nonablation reference patients at a median of 1.0 years (P=0.046).

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Why the study?

When refractory ventricular fibrillation is accompanied by infrequent and multifocal premature ventricular complexes, the optimal treatment strategy is uncertain.

Does ventricular fibrillation electrical substrate ablation reduce the composite of implantable cardioverter-defibrillator shock, electrical storm, or all-cause mortality in patients with refractory ventricular fibrillation and infrequent, multifocal premature ventricular complexes?

Comparison

VF electrical substrate ablation vs nonablation reference group

Design

Prospective comparative cohort study

Follow-up

Median 1.0 years

Authors

DKDavid E. KrummenGHGordon HoKHKurt S. Hoffmayer

Discussion

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Overview

May support VF ablation in refractory VF; hypothesis-generating from small cohort, needs randomized confirmation.

Structured PICO

Does ventricular fibrillation electrical substrate ablation reduce the composite of implantable cardioverter-defibrillator shock, electrical storm, or all-cause mortality in patients with refractory ventricular fibrillation and infrequent, multifocal premature ventricular complexes?

P
Population
12 patients (6 in ablation group, 6 in reference group) presenting with multiple implantable cardioverter-defibrillator shocks for ventricular fibrillation refractory to antiarrhythmic drug therapy, exhibiting infrequent (≤3%), multifocal premature ventricular complexes (≥3 morphologies). Ablation group: mean age 60±10 years, LVEF 46±19%, ischemic (n=3) and nonischemic cardiomyopathy.
I
Intervention
Ventricular fibrillation electrical substrate ablation (radiofrequency ablation targeting sites of localized reentry, conduction slowing and rotation, or rapid focal activation mapped during induced VF, performed during sinus rhythm)
C
Comparator
Nonablation reference patients with ventricular fibrillation who were unable or unwilling to undergo catheter ablation
O
Outcome
Composite of implantable cardioverter-defibrillator shock, electrical storm, or all-cause mortalitycomposite

Electrical substrate ablation of ventricular fibrillation may significantly reduce the risk of ICD shocks, electrical storm, and mortality in patients with refractory VF and infrequent, multifocal PVCs.

Cite This Study

Krummen et al. (2021) studied this question.

synapsesocial.com/papers/6a1b822e6a7f159d19e8d456https://doi.org/10.1161/circep.120.008868
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