Catheter ablation for primary ischemic ventricular fibrillation resulted in newly emergent Purkinje-related monomorphic VT in 29% of patients who previously had only VF.
Observational (n=21)
What is the prevalence and mechanism of newly emergent monomorphic VT after catheter ablation for primary VF in patients with ischemic heart disease?
Over one fifth of patients with primary ischemic VF develop newly emergent Purkinje-related monomorphic VT after VF ablation, which can be successfully treated with additional ablation in the same low-voltage area.
BACKGROUND: Catheter ablation is an effective therapy for ventricular fibrillation (VF) arising from the Purkinje system in ischemic heart disease. However, some patients experience newly emergent monomorphic ventricular tachycardia (VT) after the ablation of VF. We evaluated the prevalence and mechanism of monomorphic VT after VF ablation. METHODS AND RESULTS: Twenty-one consecutive patients with primary VF because of ischemic heart disease who underwent catheter ablation were retrospectively analyzed. Twenty of 21 patients were in electrical storm. Ventricular premature contractions triggering VF arose from the left Purkinje system and were targeted for ablation. Before the ablation, 14 of 21 patients had only VF, and the other 7 had VF and concomitant monomorphic VT. Four of the 14 patients with only VF (29%) exhibited newly emergent monomorphic VT after VF ablation. Three of these patients had Purkinje-related VTs, which were successfully eliminated by the ablation of a Purkinje network located in the same low-voltage area as the site of prior successful VF ablation. During a median follow-up of 28 months (interquartile range, 16-68 months), VF recurred in 6 of 21 patients (29%); however, there were neither electrical storms nor monomorphic VT, and all recurring arrhythmias were controlled by medical therapy alone. CONCLUSIONS: Over one fifth of patients with primary ischemic VF experienced newly emergent Purkinje-related monomorphic VT after VF ablation. The circuit of the monomorphic VT associated with the Purkinje network was located in the same low-voltage area as the Purkinje tissue that triggered VF and could be suppressed by additional ablation.
Masuda et al. (Thu,) conducted a observational in primary ventricular fibrillation due to ischemic heart disease (n=21). Catheter ablation was evaluated on prevalence of newly emergent monomorphic VT after VF ablation. Catheter ablation for primary ischemic ventricular fibrillation resulted in newly emergent Purkinje-related monomorphic VT in 29% of patients who previously had only VF.