Mapping and ablation of idiopathic ventricular fibrillation.
BACKGROUND
Ventricular fibrillation is the main mechanism of sudden cardiac death. The feasibility of eliminating recurrent episodes by catheter ablation has not been reported.


RESULTS
Twenty-seven patients without known heart disease (13 men, 14 women, 41+/-14 years of age) were studied after being resuscitated from recurrent (10+/-12) episodes of primary idiopathic ventricular fibrillation; 23 had received a defibrillator. The first initiating beat of ventricular fibrillation had an identical electrocardiographic morphology and coupling interval (297+/-41 ms) to preceding isolated premature beats typically noted in the aftermath of resuscitation. These triggers were localized by mapping the earliest electrical activity and ablated by local radiofrequency delivery. Outcome was assessed by Holter and defibrillator memory interrogation. Premature beats were elicited from the Purkinje conducting system in 23 patients: from the left ventricular septum in 10, from the anterior right ventricle in 9, and from both in 4. The interval from the Purkinje potential to the following myocardial activation varied from 10 to 150 ms during premature beat but was 11+/-5 ms during sinus rhythm, indicating location at peripheral Purkinje arborization. The premature beats originated from the right ventricular outflow tract muscle in 4 patients. The accuracy of mapping was confirmed by acute elimination of premature beats during local radiofrequency delivery. During a follow-up of 24+/-28 months, 24 patients (89%) had no recurrence of ventricular fibrillation without drug.


CONCLUSIONS
Primary idiopathic ventricular fibrillation is a syndrome characterized by dominant triggers from the distal Purkinje system. These sources can be eliminated by focal energy delivery.
Hôpital Haut-Lévêque, Bordeaux-Pessac, France. jacques.clementy@pu.u-bordeaux2.fr
Michel
M
Haïssaguerre
Morio
M
Shoda
Pierre
P
Jaïs
Akihiko
A
Nogami
Dipen C
DC
Shah
Josef
J
Kautzner
Thomas
T
Arentz
Dietrich
D
Kalushe
Dominique
D
Lamaison
Mike
M
Griffith
Fernando
F
Cruz
Angelo
A
de Paola
Fiorenzo
F
Gaïta
Mélèze
M
Hocini
Stéphane
S
Garrigue
Laurent
L
Macle
Rukshen
R
Weerasooriya
Jacques
J
Clémenty
D000328:Adult; D018780:Body Surface Potential Mapping; D017115:Catheter Ablation; D017023:Coronary Angiography; D016757:Death, Sudden, Cardiac / Q000517:prevention & control; D004699:Endocardium; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011690:Purkinje Fibers; D014693:Ventricular Fibrillation / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery*