Keita Masuda1, Akihiko Nogami2, Kenji Kuroki1, Miyako Igarashi1, Yukio Sekiguchi1, Yuki Komatsu1, Shinya Kowase1, Kenji Kurosaki1, Shuzo Nishihara1, Koichiro Niwa1, Taketsugu Tsuchiya1, Masayuki Igawa1, Kazutaka Aonuma1. 1. From the Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan (K.M., A.N., K. Kuroki, M. Igarashi, Y.S., K.A.); Department of Heart Rhythm Management, Yokohama Rosai Hospital, Kanagawa, Japan (A.N., Y.K., S.K., K. Kurosaki); Department of Cardiology, St. Luke's International Hospital, Chuo, Tokyo, Japan (S.N., K.N.); Division of Cardiology, Kanazawa Cardiovascular Hospital, Ishikawa, Japan (T.T.); and Division of Cardiology, Tsukuba Memorial Hospital, Ibaraki, Japan (M. Igawa). 2. From the Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan (K.M., A.N., K. Kuroki, M. Igarashi, Y.S., K.A.); Department of Heart Rhythm Management, Yokohama Rosai Hospital, Kanagawa, Japan (A.N., Y.K., S.K., K. Kurosaki); Department of Cardiology, St. Luke's International Hospital, Chuo, Tokyo, Japan (S.N., K.N.); Division of Cardiology, Kanazawa Cardiovascular Hospital, Ishikawa, Japan (T.T.); and Division of Cardiology, Tsukuba Memorial Hospital, Ibaraki, Japan (M. Igawa). akihiko-ind@umin.ac.jp.
Abstract
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.
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.
Authors: Victor Garcia-Bustos; Rafael Sebastian; Maite Izquierdo; César Rios-Navarro; Vicente Bodí; Francisco Javier Chorro; Amparo Ruiz-Sauri Journal: PLoS One Date: 2019-02-11 Impact factor: 3.240