March 23, 2021Open Access
Why Ablation of Sites With Purkinje Activation Is Antiarrhythmic: The Interplay Between Fast Activation and Arrhythmogenesis
Key Result
Computer simulations suggest that deeper penetration of the Purkinje network into the ventricular wall shortens QRS50 and produces J-waves, potentially facilitating unidirectional block and reentry.
Structured PICO
Does ablation of sites showing Purkinje activity reduce arrhythmogenesis in patients with idiopathic ventricular fibrillation?
P
Population
Patients with idiopathic ventricular fibrillation (iVF)
I
Intervention
Ablation of sites showing Purkinje activity
This paper proposes a mechanistic explanation for the antiarrhythmic effect of Purkinje network ablation in idiopathic ventricular fibrillation, highlighting the role of fast activation and repolarization gradients.
Limitations
- The ideas are speculative and not substantiated by systematic clinical studies.
- The computer model was not tested for arrhythmogenesis.
- Whether the Purkinje system indeed penetrates deeper into the ventricular wall of patients with idiopathic ventricular fibrillation is yet to be investigated.
Abstract
Ablation of sites showing Purkinje activity is antiarrhythmic in some patients with idiopathic ventricular fibrillation (iVF). The mechanism for the therapeutic success of ablation is not fully understood. We propose that deeper penetrance of the Purkinje network allows faster activation of the ventricles and is proarrhythmic in the presence of steep repolarization gradients. Reduction of Purkinje penetrance, or its indirect reducing effect on apparent propagation velocity may be a therapeutic target in patients with iVF.
Cite This Study
Coronel et al. (Tue,) conducted a other in Idiopathic ventricular fibrillation. Deeper penetration of Purkinje network (computer simulation) vs. Normal penetration (2 mm) was evaluated on QRS50 duration and morphology. Computer simulations suggest that deeper penetration of the Purkinje network into the ventricular wall shortens QRS50 and produces J-waves, potentially facilitating unidirectional block and reentry.