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Purkinje network and myocardial substrate at the onset of human ventricular fibrillation: implications for catheter ablation

Abstract

This research examined the cardiac mechanisms initiating ventricular fibrillation in 54 patients with various heart conditions using specialized mapping techniques. Findings demonstrated that approximately 81% of arrhythmia drivers originated from substrate-related areas. The Purkinje system triggered or drove fibrillation in 43% of patients with cardiomyopathy. Initial organized activity transitioned to disorganized fibrillation through accelerating reentrant mechanisms. Following targeted ablation of Purkinje tissue and substrate regions, VF recurrence rates decreased substantially from median seven episodes pre-procedure to zero episodes post-procedure over a median 56 ± 30 months follow-up period.

Conclusion: Human ventricular fibrillation onset involves coordinated Purkinje and structural substrate activities before spatial dissemination occurs. Targeted catheter ablation effectively reduces arrhythmia recurrence burden.

Publication Information

Journal: European Heart Journal
Volume: 43, Issue 12
Pages: 1234-1247
Publication Date: March 21, 2022
DOI: 10.1093/eurheartj/ehab893
PMID: 35134898
PubMed Link: https://pubmed.ncbi.nlm.nih.gov/35134898/

Authors

Michel Haissaguerre, Ghassen Cheniti, Meleze Hocini, Frederic Sacher, F Daniel Ramirez, Hubert Cochet, Laura Bear, Romain Tixier, Josselin Duchateau, Rick Walton, Elodie Surget, Tsukasa Kamakura, Hugo Marchand, Nicolas Derval, Pierre Bordachar, Sylvain Ploux, Takamitsu Takagi, Thomas Pambrun, Pierre Jais, Louis Labrousse, Mark Strik, Hiroshi Ashikaga, Hugh Calkins, Ed Vigmond, Koonlawee Nademanee, Olivier Bernus, Remi Dubois

Publications Pulsheart et IHU Lyric