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Distinct Substrates of Idiopathic Ventricular Fibrillation Revealed by Arrhythmia Characteristics on Implantable Cardioverter-Defibrillator

Abstract

This multicenter study examined 95 patients with idiopathic ventricular fibrillation (IVF) to identify distinct underlying substrates. Researchers analyzed implantable defibrillator electrogram recordings of 117 arrhythmia recurrences to evaluate characteristics preceding VF episodes.

Key findings revealed that microstructural cardiomyopathic alterations (41 patients) versus Purkinje-related substrates (54 patients) demonstrated distinct phenotypic markers. The Purkinje substrate group exhibited short-coupled (<350 ms) triggers occurring in 95.5% of cases compared to 23.1% in the cardiomyopathy group. Purkinje-related VF demonstrated significantly shorter cycle lengths (182±15 ms versus 215±24 ms).

Conversely, sinus tachycardia preceded cardiomyopathy-related episodes more frequently (35.9% versus 13.4%). A multivariable analysis achieved 93% accuracy in discriminating substrates, successfully identifying 81% of cases with high probability (>80%), providing important clinical and genetic implications for IVF management.

Publication Information

Journal: JACC Clinical Electrophysiology
Volume: 10, Issue 9
Pages: 1982-1994
Publication Date: September 2024
DOI: 10.1016/j.jacep.2024.04.028
PMID: 38970599
Study Type: Multicenter Observational Study
PubMed Link: https://pubmed.ncbi.nlm.nih.gov/38970599/
JACC Link: https://www.jacc.org/doi/10.1016/j.jacep.2024.04.028

Lead Author

Michel Haïssaguerre (IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital, France)