Key result
RF ablation targeting inferior RV Purkinje potentials eliminates VPBs and prevents inducible ventricular arrhythmias.
Why the study?
Idiopathic ventricular fibrillation can be triggered by Purkinje potentials from various ventricular regions, but the role of right ventricular inferior region triggers was not well characterized.
Does radiofrequency ablation targeting Purkinje potentials eliminate VPBs and prevent inducible ventricular arrhythmia in a patient with idiopathic VF?
Case Report (n=1)
Does radiofrequency ablation targeting Purkinje potentials eliminate VPBs and prevent inducible ventricular arrhythmia in a patient with idiopathic VF?
Radiofrequency ablation targeting Purkinje potentials in the inferior right ventricle can successfully treat idiopathic ventricular fibrillation triggered by monofocal VPBs.
Answers are grounded in this paper and cite their sources.
May inform ablation targets in refractory ventricular arrhythmias; leaves open need for prospective validation.
A previously healthy 54-year-old female was successfully resuscitated from cardiac arrest caused by ventricular fibrillation (VF). Coronary angiography and echocardiogram were normal. The ECG showed neither signs of Brugada and early repolarization syndromes, nor of long- and short-QT syndromes. She had episodes of VF-storm, triggered by monofocal ventricular premature beats (VPBs) with R on T phenomena. The morphology of the monofocal VPB indicated eminence from the inferior region of the right ventricle (RV).1 During sinus rhythm, Purkinje potentials coincided with start of QRS-complex, while it preceded the VPB by 22 ± 12 ms (Panel A). A pace mapping with 12/12 match with the clinical VPB was obtained from the inferior region towards the apex (Panel B, yellow arrow). Radiofrequency delivery to the inferior region of the RV, targeting Purkinje potentials eliminated the VPB and programmed ventricular stimulation was negative for any inducible ventricular arrhythmia. In the previously reported series of patients with idiopathic VF, the source of Purkinje potentials recorded from RV were from anterior region. Apparently any area of right or left ventricle harbouring Purkinje potentials could be a trigger for VF. The full-length version of this report can be viewed at: http://www.escardio.org/communities/EHRA/publications/ep-case-reports/Documents/ablation-idiopathic-ventricular-fibrillation-Purkinje.pdf
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Ayou et al. (2013) conducted a case report in Idiopathic ventricular fibrillation (n=1). Radiofrequency ablation targeting Purkinje potentials was evaluated on Elimination of VPB and non-inducibility of ventricular arrhythmia. Radiofrequency ablation targeting Purkinje potentials in the inferior region of the right ventricle successfully eliminated ventricular premature beats and prevented inducible ventricular arrhythmia.
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