Ventricular Fibrillation Triggered by PVCs from Papillary Muscles: Clinical Features and Ablation

“…Currently, there is no cure for VF, with only rudimentary treatment options available; thus, sudden cardiac death from VF remains a major worldwide health problem 3, 4. The Purkinje system is implicated in the genesis of primary VF,5, 6, 7 with radiofrequency ablation successfully treating this lethal arrhythmia by targeting triggers, such as a premature ventricular beat emanating from Purkinje tissue 7, 8, 9, 10. However, current radiofrequency ablation approaches to the Purkinje fibers have limitations, particularly because they can only be applied in a point‐to‐point manner, which is tedious and time‐consuming.…”

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confidence: 99%

Elimination of Purkinje Fibers by Electroporation Reduces Ventricular Fibrillation Vulnerability

Livia

Sugrue

Witt

et al. 2018

JAHA

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BackgroundThe Purkinje network appears to play a pivotal role in the triggering as well as maintenance of ventricular fibrillation. Irreversible electroporation (IRE) using direct current has shown promise as a nonthermal ablation modality in the heart, but its ability to target and ablate the Purkinje tissue is undefined. Our aim was to investigate the potential for selective ablation of Purkinje/fascicular fibers using IRE.Methods and ResultsIn an ex vivo Langendorff model of canine heart (n=8), direct current was delivered in a unipolar manner at various dosages from 750 to 2500 V, in 10 pulses with a 90‐μs duration at a frequency of 1 Hz. The window of ventricular fibrillation vulnerability was assessed before and after delivery of electroporation energy using a shock on T‐wave method. IRE consistently eradicated all Purkinje potentials at voltages between 750 and 2500 V (minimum field strength of 250–833 V/cm). The ventricular electrogram amplitude was only minimally reduced by ablation: 0.6±2.3 mV (P=0.03). In 4 hearts after IRE delivery, ventricular fibrillation could not be reinduced. At baseline, the lower limit of vulnerability to ventricular fibrillation was 1.8±0.4 J, and the upper limit of vulnerability was 19.5±3.0 J. The window of vulnerability was 17.8±2.9 J. Delivery of electroporation energy significantly reduced the window of vulnerability to 5.7±2.9 J (P=0.0003), with a postablation lower limit of vulnerability=7.3±2.63 J, and the upper limit of vulnerability=18.8±5.2 J.ConclusionsOur study highlights that Purkinje tissue can be ablated with IRE without any evidence of underlying myocardial damage.

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“…In the accident and emergency department or in the critical care unit, this will offer time to prepare therapeutic maneuvers which can be life saving. Finally, the J index offers a mechanism for furthering investigation not triggering mechanisms for VAs [28][29][30].…”

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confidence: 99%

Prompt and accurate diagnosis of ventricular arrhythmias with a novel index based on phase space reconstruction of ECG

Koulaouzidis

Das

Cappiello

et al. 2015

International Journal of Cardiology

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Aim: To develop a statistical index based on the phase space reconstruction (PSR) of the electrocardiogram (ECG) for the accurate and timely diagnosis of ventricular tachycardia (VT) and ventricular fibrillation (VF). Methods: Thirty-two ECGs with sinus rhythm (SR) and 32 ECGs with VT/VF were analyzed using the PSR technique. Firstly, the method of time delay embedding were employed with the insertion of delay "τ" in the original time-series X(t), which produces the Y(t) = X(t − τ). Afterwards, a PSR diagram was reconstructed by plotting Y(t) against X(t). The method of box counting was applied to analyze the behavior of the PSR trajectories. Measures as mean (μ), standard deviation (σ) and coefficient of variation (CV = σ/μ), kurtosis (β) for the box counting of PSR diagrams were reported. Results: During SR, CV was always b0.05, while with the onset of arrhythmia CV increased N0.05. A similar pattern was observed with β, where b 6 was considered as the cut-off point between SR and VT/VF. Therefore, the upper threshold for SR was considered CV th = 0.05 and β th b 6. For optimisation of the accuracy, a new index (J) was proposed: J ¼ w CV CV th þ 1−w ð Þ β β th : During SR the upper limit of J was the value of 1. Furthermore CV, β and J crossed the cut-off point timely before the onset of arrhythmia (average time: 4 min 31 s; SD: 2 min 30 s); allowing sufficient time for preventive therapy. Conclusion: The J index improved ECG utility for arrhythmia monitoring and detection utility, allowing the prompt and accurate diagnosis of ventricular arrhythmias.

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Ventricular Fibrillation Triggered by PVCs from Papillary Muscles: Clinical Features and Ablation

Cited by 107 publications

References 28 publications

Ablating Premature Ventricular Complexes: Justification, Techniques, and Outcomes

Ablating Premature Ventricular Complexes: Justification, Techniques, and Outcomes

Elimination of Purkinje Fibers by Electroporation Reduces Ventricular Fibrillation Vulnerability

Prompt and accurate diagnosis of ventricular arrhythmias with a novel index based on phase space reconstruction of ECG

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