Key result
Ablation of the triggering ventricular ectopic beat, pace-mapped to the left posterior hemi-fascicle, was successful in treating anti-arrhythmic resistant polymorphic VT and VF in a young man.
Case Report (n=1)
Ablation of triggering PVCs originating from the Purkinje network can be an effective treatment for drug-resistant idiopathic ventricular fibrillation.
May support Purkinje PVC ablation in select refractory VF cases; leaves open need for prospective validation.
A young man suffered cardiac arrests with polymorphic ventricular tachycardia (PVT) and ventricular fibrillation (VF) triggered by ventricular premature contractions (PVCs). The arrhythmia was resistant to anti-arrhythmics, so after ICD implantation he underwent successful ablation of the triggering VE beat, which was pace-mapped to the left posterior hemi-fascicle. We review the evidence for the role of the Purkinje network in the initiation and maintenance of PVT and VF, postulating a channelopathy as a possible underlying cause, and provide recommendations for PVC ablation.
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Martin et al. (2017) conducted a case report in Idiopathic ventricular fibrillation and polymorphic ventricular tachycardia (n=1). Ablation of the triggering ventricular ectopic beat was evaluated on Successful ablation. Ablation of the triggering ventricular ectopic beat, pace-mapped to the left posterior hemi-fascicle, was successful in treating anti-arrhythmic resistant polymorphic VT and VF in a young man.
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