This narrative review synthesizes current knowledge on Purkinje-triggered ventricular fibrillation and evaluates evolving management strategies such as substrate-based Purkinje de-networking.
This review highlights the evolving understanding of Purkinje-triggered ventricular fibrillation and contrasts conventional focal ablation with novel substrate-based approaches like Purkinje de-networking.
Ventricular fibrillation (VF) is the primary arrhythmia causing sudden cardiac death. While typically linked to structural heart disease, a significant subset of VF episodes-especially in younger individuals-is triggered by focal ectopy from the His-Purkinje system (HPS). The HPS possesses distinct electrophysiological properties that make it inherently susceptible to arrhythmogenesis. It serves a dual role, acting as both a primary source of initiating premature ventricular complexes through abnormal automaticity and triggered activity (early and delayed afterdepolarizations), and as a critical substrate maintaining VF via micro-re-entrant circuits. This narrative review comprehensively synthesizes current knowledge on Purkinje-triggered VF, from its epidemiology and clinical setting to its underlying pathophysiological and ionic mechanisms of arrhythmia initiation and perpetuation. Finally, we critically evaluate contemporary diagnostic and management strategies, contrasting conventional focal trigger-based ablation with evolving substrate-based approaches such as Purkinje "de-networking."
Mugnai et al. (Sun,) conducted a review in Idiopathic Ventricular Fibrillation. Diagnostic and management strategies (focal ablation and Purkinje de-networking) was evaluated. This narrative review synthesizes current knowledge on Purkinje-triggered ventricular fibrillation and evaluates evolving management strategies such as substrate-based Purkinje de-networking.