Abstract
Introduction: Ventricular fibrillation (VF) represents the primary mechanism of sudden cardiac death in hypertrophic cardiomyopathy (HCM) patients. Understanding VF origins and catheter ablation efficacy for recurrent episodes remains unclear.
Methods and results: Between 2010-2014, five HCM patients (mean age 21 ± 9 years; three female) underwent invasive electrophysiological studies and ablation following resuscitation from repeated VF episodes (9 ± 7 occurrences). Ventricular premature beats initiating VF were recorded noninvasively preoperatively. Postprocedural CT imaging in three patients correlated ablation sites with myocardial hypertrophy. VF triggers originated from the distal left Purkinje conduction system: left posterior fascicle (2 patients), left anterior fascicle (1 patient), and both fascicles (2 patients). Radiofrequency ablation successfully eliminated all VF triggers. Ablation sites corresponded to hypertrophied segments in 93 ± 12% of cases. During follow-up (50 ± 38 months), four of five patients remained VF-free without antiarrhythmic medications; one patient experienced single recurrence after 13 prior episodes.
Conclusion: VF in HCM patients originated from Purkinje tissue rather than myocardium, colocalizing with hypertrophic regions. Focal ablation substantially reduced VF burden.
Publication Information
- Journal: Journal of Cardiovascular Electrophysiology
- Volume: 32, Issue 11
- Pages: 3003-3013
- Publication Date: November 2021
- DOI: 10.1111/jce.15231
- PMID: 34453363
- PubMed Link: https://pubmed.ncbi.nlm.nih.gov/34453363/