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Journal of Interventional Cardiac Electrophysiology

Published in:

01-08-2018

The role of the Purkinje network in premature ventricular complex-triggered ventricular fibrillation

Authors: Carola Gianni, J David Burkhardt, Chintan Trivedi, Sanghamitra Mohanty, Andrea Natale

Published in: Journal of Interventional Cardiac Electrophysiology | Issue 3/2018

Abstract

The Purkinje network (PN) is the distal part of the ventricular conduction system, which has shown to play a central role in the pathophysiology of ventricular fibrillation (VF). Abnormal automaticity and triggered activity are commonly seen in the PN, and the resulting premature ventricular complexes (PVCs) are frequently recognized as triggers of this life-threatening arrhythmia. Catheter ablation targeting PN-related PVCs can be successfully performed in patients with medically refractory VF in a variety of arrhythmic substrates.

Eliška O. Purkynje fibers of the heart conduction system. Cas Lek Cesk. 2006;145(4):329–35.PubMed

Moorman AFM, Christoffels VM. Cardiac chamber formation: development, genes, and evolution. Physiol Rev. 2003;83(4):1223–67. https://doi.org/10.1152/physrev.00006.2003.CrossRefPubMed

Mangoni ME, Nargeot J. Genesis and regulation of the heart automaticity. Physiol Rev. 2008;88(3):919–82. https://doi.org/10.1152/physrev.00018.2007.CrossRefPubMed

Haissaguerre M, Vigmond E, Stuyvers B, Hocini M, Bernus O. Ventricular arrhythmias and the His-Purkinje system. Nat Rev Cardiol. 2016;13(3):155–66. https://doi.org/10.1038/nrcardio.2015.193.CrossRefPubMed

Tabereaux PB, Dosdall DJ, Ideker RE. Mechanisms of VF maintenance: wandering wavelets, mother rotors, or foci. Heart Rhythm. 2009;6(3):405–15. https://doi.org/10.1016/j.hrthm.2008.11.005.CrossRefPubMed

Mahoney T, Arruda M, Natale A, Tchou P, Schweikert R. Catheter ablation of ventricular fibrillation and polymorphic ventricular tachycardia. In: Natale A, editor. Handbook of Cardiac Electrophysiology. 2nd ed: CRC Press; 2007.

Haïssaguerre M, Shoda M, Jaïs P, Nogami A, Shah DC, Kautzner J, et al. Mapping and ablation of idiopathic ventricular fibrillation. Circulation. 2002;106(8):962–7. https://doi.org/10.1161/01.CIR.0000027564.55739.B1.CrossRefPubMed

Marrouche NF, Verma A, Wazni O, Schweikert R, Martin DO, Saliba W, et al. Mode of initiation and ablation of ventricular fibrillation storms in patients with ischemic cardiomyopathy. J Am Coll Cardiol. 2004;43(9):1715–20. https://doi.org/10.1016/j.jacc.2004.03.004.CrossRefPubMed

Leenhardt A, Glaser E, Burguera M, Nürnberg M, Maison-Blanche P, Coumel P. Short-coupled variant of torsade de pointes: a new electrocardiographic entity in the spectrum of idiopathic ventricular tachyarrhythmias. Circulation. 1994;89(1):206–15. https://doi.org/10.1161/01.CIR.89.1.206.CrossRefPubMed

10.

Belhassen B, Viskin S, Fish R. Glick a, Setbon I, Eldar M. Effects of electrophysiologic-guided therapy with Class IA antiarrhythmic drugs on the long-term outcome of patients with idiopathic ventricular fibrillation with or without the Brugada syndrome. J Cardiovasc Electrophysiol. 1999;10(10):1301–12.CrossRefPubMed

11.

Haïssaguerre M, Shah DC, Jaïs P, Shoda M, Kautzner J, Arentz T, et al. Role of Purkinje conducting system in triggering of idiopathic ventricular fibrillation. Lancet. 2002;359(9307):677–8. https://doi.org/10.1016/S0140-6736(02)07807-8.CrossRefPubMed

12.

Haïssaguerre M, Extramiana F, Hocini M, Cauchemez B, Jaïs P, Cabrera JA, et al. Mapping and ablation of ventricular fibrillation associated with long-QT and Brugada syndromes. Circulation. 2003;108(8):925–8. https://doi.org/10.1161/01.CIR.0000088781.99943.95.CrossRefPubMed

13.

Haïssaguerre M, Derval N, Sacher F, Jesel L, Deisenhofer I, de Roy L, et al. Sudden cardiac arrest associated with early repolarization. N Engl J Med. 2008;358(19):2016–23. https://doi.org/10.1056/NEJMoa071968.CrossRefPubMed

14.

Knecht S, Sacher F, Wright M, Hocini M, Nogami A, Arentz T, et al. Long-term follow-up of idiopathic ventricular fibrillation ablation. A Multicenter Study. J Am Coll Cardiol. 2009;54(6):522–8. https://doi.org/10.1016/j.jacc.2009.03.065.CrossRefPubMed

15.

Van Herendael H, Zado ES, Haqqani H, Tschabrunn CM, Callans DJ, Frankel DS, et al. Catheter ablation of ventricular fibrillation: importance of left ventricular outflow tract and papillary muscle triggers. Heart Rhythm. 2014;11(4):566–73. https://doi.org/10.1016/j.hrthm.2013.12.030.CrossRefPubMed

16.

Noda T, Shimizu W, Taguchi A, Aiba T, Satomi K, Suyama K, et al. Malignant entity of idiopathic ventricular fibrillation and polymorphic ventricular tachycardia initiated by premature extrasystoles originating from the right ventricular outflow tract. J Am Coll Cardiol. 2005;46(7):1288–94. https://doi.org/10.1016/j.jacc.2005.05.077.CrossRefPubMed

17.

Santoro F, Di Biase L, Hranitzky P, Sanchez JE, Santangeli P, Paoletti Perini A, et al. Ventricular fibrillation triggered by PVCs from papillary muscles: clinical features and ablation. J Cardiovasc Electrophysiol. 2014;25(11):1158–64. https://doi.org/10.1111/jce.12478.CrossRefPubMed

18.

Nademanee K, Veerakul G, Chandanamattha P, Chaothawee L, Ariyachaipanich A, Jirasirirojanakorn K, et al. Prevention of ventricular fibrillation episodes in brugada syndrome by catheter ablation over the anterior right ventricular outflow tract epicardium. Circulation. 2011;123(12):1270–9. https://doi.org/10.1161/CIRCULATIONAHA.110.972612. CrossRefPubMed

19.

Bänsch D, Oyang F, Antz M, Arentz T, Weber R, Val-Mejias JE, et al. Successful catheter ablation of electrical storm after myocardial infarction. Circulation. 2003;108(24):3011–6. https://doi.org/10.1161/01.CIR.0000103701.30662.5C.CrossRefPubMed

20.

Szumowski L, Sanders P, Walczak F, Hocini M, Jaïs P, Kepski R, et al. Mapping and ablation of polymorphic ventricular tachycardia after myocardial infarction. J Am Coll Cardiol. 2004;44(8):1700–6. https://doi.org/10.1016/j.jacc.2004.08.034.CrossRefPubMed

21.

Enjoji Y, Mizobuchi M, Muranishi H, Miyamoto C, Utsunomiya M, Funatsu A, et al. Catheter ablation of fatal ventricular tachyarrhythmias storm in acute coronary syndrome-role of Purkinje fiber network. J Interv Card Electrophysiol. 2009;26(3):207–15. https://doi.org/10.1007/s10840-009-9394-7.CrossRefPubMed

22.

Peichl P, Čihák R, Koželuhová M, Wichterle D, Vančura V, Kautzner J. Catheter ablation of arrhythmic storm triggered by monomorphic ectopic beats in patients with coronary artery disease. J Interv Card Electrophysiol. 2010;27(1):51–9. https://doi.org/10.1007/s10840-009-9443-2.CrossRefPubMed

23.

Bode K, Hindricks G, Piorkowski C, Sommer P, Janoušek J, Dagres N, et al. Ablation of polymorphic ventricular tachycardias in patients with structural heart disease. Pacing Clin Electrophysiol. 2008;31(12):1585–91. https://doi.org/10.1111/j.1540-8159.2008.01230.x.CrossRefPubMed

24.

Kobayashi Y, Iwasaki Y, Miyauchi Y, Hayashi M, Ohno N, Yodogawa K, et al. The role of Purkinje fibers in the emergence of an incessant form of polymorphic ventricular tachycardia or ventricular fibrillation associated with ischemic heart disease. J Arrhythmia. 2008;24(4):200–8. https://doi.org/10.1016/S1880-4276(08)80029-4.CrossRef

25.

Hayashi M, Miyauchi Y, Murata H, Takahashi K, Tsuboi I, Uetake S, et al. Urgent catheter ablation for sustained ventricular tachyarrhythmias in patients with acute heart failure decompensation. Europace. 2014;16(1):92–100. https://doi.org/10.1093/europace/eut207.CrossRefPubMed

26.

Sinha AM, Schmidt M, Marschang H, Gutleben K, Ritscher G, Brachmann J, et al. Role of left ventricular scar and purkinje-like potentials during mapping and ablation of ventricular fibrillation in dilated cardiomyopathy. Pacing Clin Electrophysiol. 2009;32(3):286–90. https://doi.org/10.1111/j.1540-8159.2008.02233.x.CrossRefPubMed

27.

Mlcochova H, Saliba WI, Burkhardt DJ, Rodriguez RE, Cummings JE, Lakkireddy D, et al. Catheter ablation of ventricular fibrillation storm in patients with infiltrative amyloidosis of the heart. J Cardiovasc Electrophysiol. 2006;17(4):426–30. https://doi.org/10.1111/j.1540-8167.2005.00321.x.CrossRefPubMed

28.

Friedman PL, Stewart JR, Fenoglio JJ, Wit AL. Survival of subendocardial Purkinje fibers after extensive myocardial infarction in dogs. Circ Res. 1973;33(5):597–611. https://doi.org/10.1161/01.RES.33.5.597. CrossRefPubMed

Title: The role of the Purkinje network in premature ventricular complex-triggered ventricular fibrillation
Authors: Carola Gianni
J David Burkhardt
Chintan Trivedi
Sanghamitra Mohanty
Andrea Natale
Publication date: 01-08-2018
Publisher: Springer US
Published in: Journal of Interventional Cardiac Electrophysiology / Issue 3/2018
Print ISSN: 1383-875X
Electronic ISSN: 1572-8595
DOI: https://doi.org/10.1007/s10840-018-0402-7

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