Ventricular fibrillation: combined myocardial substrate and Purkinje ablation

This editorial refers to ‘Purkinje network and myocardial substrate at the onset of human ventricular fibrillation: implications for catheter ablation’, by M. Haissaguerre et al., https://doi.org/10.1093/eurheartj/ehab893. Since the earliest documented accounts of ventricular fibrillation (VF) >3000 years ago,1 the mechanisms responsible have been the source of ongoing debate. During the early part of the last century, both focal and re-entrant mechanisms were proposed, and more recently the re-entry mechanisms have polarized into the multiple wavelet and mother rotor hypotheses. The multiple wavelet hypothesis, originally put forward by Moe2 to explain atrial fibrillation, implies that VF is sustained by multiple circulating unstable wavelets perpetuated by a sequence of wavebreaks and self-generating re-entry. The mother rotor hypothesis3 proposes that VF is maintained by a single rapid periodic source that is unable to sustain uniform 1:1 conduction throughout the myocardium, resulting in intermittent conduction block with multiple irregular...