title: Conversion to Purkinje-Related Monomorphic Ventricular Tachycardia After Ablation of Ventricular Fibrillation in Ischemic Heart Disease.
abstract: Catheter ablation is an effective therapy for ventricular fibrillation (VF) arising from the Purkinje system in ischemic heart disease. However, some patients experience newly emergent monomorphic ventricular tachycardia (VT) after the ablation of VF. We evaluated the prevalence and mechanism of monomorphic VT after VF ablation.
  
  
  
  Twenty-one consecutive patients with primary VF because of ischemic heart disease who underwent catheter ablation were retrospectively analyzed. Twenty of 21 patients were in electrical storm. Ventricular premature contractions triggering VF arose from the left Purkinje system and were targeted for ablation. Before the ablation, 14 of 21 patients had only VF, and the other 7 had VF and concomitant monomorphic VT. Four of the 14 patients with only VF (29%) exhibited newly emergent monomorphic VT after VF ablation. Three of these patients had Purkinje-related VTs, which were successfully eliminated by the ablation of a Purkinje network located in the same low-voltage area as the site of prior successful VF ablation. During a median follow-up of 28 months (interquartile range, 16-68 months), VF recurred in 6 of 21 patients (29%); however, there were neither electrical storms nor monomorphic VT, and all recurring arrhythmias were controlled by medical therapy alone.
  
  
  
  Over one fifth of patients with primary ischemic VF experienced newly emergent Purkinje-related monomorphic VT after VF ablation. The circuit of the monomorphic VT associated with the Purkinje network was located in the same low-voltage area as the Purkinje tissue that triggered VF and could be suppressed by additional ablation.
authors.affiliation: From the Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan (K.M., A.N., K. Kuroki, M. Igarashi, Y.S., K.A.); Department of Heart Rhythm Management, Yokohama Rosai Hospital, Kanagawa, Japan (A.N., Y.K., S.K., K. Kurosaki); Department of Cardiology, St. Luke's International Hospital, Chuo, Tokyo, Japan (S.N., K.N.); Division of Cardiology, Kanazawa Cardiovascular Hospital, Ishikawa, Japan (T.T.); and Division of Cardiology, Tsukuba Memorial Hospital, Ibaraki, Japan (M. Igawa).
authors.forename: Keita
authors.initials: K
authors.lastname: Masuda
authors.affiliation: From the Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan (K.M., A.N., K. Kuroki, M. Igarashi, Y.S., K.A.); Department of Heart Rhythm Management, Yokohama Rosai Hospital, Kanagawa, Japan (A.N., Y.K., S.K., K. Kurosaki); Department of Cardiology, St. Luke's International Hospital, Chuo, Tokyo, Japan (S.N., K.N.); Division of Cardiology, Kanazawa Cardiovascular Hospital, Ishikawa, Japan (T.T.); and Division of Cardiology, Tsukuba Memorial Hospital, Ibaraki, Japan (M. Igawa). akihiko-ind@umin.ac.jp.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Nogami
authors.affiliation: From the Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan (K.M., A.N., K. Kuroki, M. Igarashi, Y.S., K.A.); Department of Heart Rhythm Management, Yokohama Rosai Hospital, Kanagawa, Japan (A.N., Y.K., S.K., K. Kurosaki); Department of Cardiology, St. Luke's International Hospital, Chuo, Tokyo, Japan (S.N., K.N.); Division of Cardiology, Kanazawa Cardiovascular Hospital, Ishikawa, Japan (T.T.); and Division of Cardiology, Tsukuba Memorial Hospital, Ibaraki, Japan (M. Igawa).
authors.forename: Kenji
authors.initials: K
authors.lastname: Kuroki
authors.affiliation: From the Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan (K.M., A.N., K. Kuroki, M. Igarashi, Y.S., K.A.); Department of Heart Rhythm Management, Yokohama Rosai Hospital, Kanagawa, Japan (A.N., Y.K., S.K., K. Kurosaki); Department of Cardiology, St. Luke's International Hospital, Chuo, Tokyo, Japan (S.N., K.N.); Division of Cardiology, Kanazawa Cardiovascular Hospital, Ishikawa, Japan (T.T.); and Division of Cardiology, Tsukuba Memorial Hospital, Ibaraki, Japan (M. Igawa).
authors.forename: Miyako
authors.initials: M
authors.lastname: Igarashi
authors.affiliation: From the Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan (K.M., A.N., K. Kuroki, M. Igarashi, Y.S., K.A.); Department of Heart Rhythm Management, Yokohama Rosai Hospital, Kanagawa, Japan (A.N., Y.K., S.K., K. Kurosaki); Department of Cardiology, St. Luke's International Hospital, Chuo, Tokyo, Japan (S.N., K.N.); Division of Cardiology, Kanazawa Cardiovascular Hospital, Ishikawa, Japan (T.T.); and Division of Cardiology, Tsukuba Memorial Hospital, Ibaraki, Japan (M. Igawa).
authors.forename: Yukio
authors.initials: Y
authors.lastname: Sekiguchi
authors.affiliation: From the Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan (K.M., A.N., K. Kuroki, M. Igarashi, Y.S., K.A.); Department of Heart Rhythm Management, Yokohama Rosai Hospital, Kanagawa, Japan (A.N., Y.K., S.K., K. Kurosaki); Department of Cardiology, St. Luke's International Hospital, Chuo, Tokyo, Japan (S.N., K.N.); Division of Cardiology, Kanazawa Cardiovascular Hospital, Ishikawa, Japan (T.T.); and Division of Cardiology, Tsukuba Memorial Hospital, Ibaraki, Japan (M. Igawa).
authors.forename: Yuki
authors.initials: Y
authors.lastname: Komatsu
authors.affiliation: From the Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan (K.M., A.N., K. Kuroki, M. Igarashi, Y.S., K.A.); Department of Heart Rhythm Management, Yokohama Rosai Hospital, Kanagawa, Japan (A.N., Y.K., S.K., K. Kurosaki); Department of Cardiology, St. Luke's International Hospital, Chuo, Tokyo, Japan (S.N., K.N.); Division of Cardiology, Kanazawa Cardiovascular Hospital, Ishikawa, Japan (T.T.); and Division of Cardiology, Tsukuba Memorial Hospital, Ibaraki, Japan (M. Igawa).
authors.forename: Shinya
authors.initials: S
authors.lastname: Kowase
authors.affiliation: From the Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan (K.M., A.N., K. Kuroki, M. Igarashi, Y.S., K.A.); Department of Heart Rhythm Management, Yokohama Rosai Hospital, Kanagawa, Japan (A.N., Y.K., S.K., K. Kurosaki); Department of Cardiology, St. Luke's International Hospital, Chuo, Tokyo, Japan (S.N., K.N.); Division of Cardiology, Kanazawa Cardiovascular Hospital, Ishikawa, Japan (T.T.); and Division of Cardiology, Tsukuba Memorial Hospital, Ibaraki, Japan (M. Igawa).
authors.forename: Kenji
authors.initials: K
authors.lastname: Kurosaki
authors.affiliation: From the Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan (K.M., A.N., K. Kuroki, M. Igarashi, Y.S., K.A.); Department of Heart Rhythm Management, Yokohama Rosai Hospital, Kanagawa, Japan (A.N., Y.K., S.K., K. Kurosaki); Department of Cardiology, St. Luke's International Hospital, Chuo, Tokyo, Japan (S.N., K.N.); Division of Cardiology, Kanazawa Cardiovascular Hospital, Ishikawa, Japan (T.T.); and Division of Cardiology, Tsukuba Memorial Hospital, Ibaraki, Japan (M. Igawa).
authors.forename: Shuzo
authors.initials: S
authors.lastname: Nishihara
authors.affiliation: From the Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan (K.M., A.N., K. Kuroki, M. Igarashi, Y.S., K.A.); Department of Heart Rhythm Management, Yokohama Rosai Hospital, Kanagawa, Japan (A.N., Y.K., S.K., K. Kurosaki); Department of Cardiology, St. Luke's International Hospital, Chuo, Tokyo, Japan (S.N., K.N.); Division of Cardiology, Kanazawa Cardiovascular Hospital, Ishikawa, Japan (T.T.); and Division of Cardiology, Tsukuba Memorial Hospital, Ibaraki, Japan (M. Igawa).
authors.forename: Koichiro
authors.initials: K
authors.lastname: Niwa
authors.affiliation: From the Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan (K.M., A.N., K. Kuroki, M. Igarashi, Y.S., K.A.); Department of Heart Rhythm Management, Yokohama Rosai Hospital, Kanagawa, Japan (A.N., Y.K., S.K., K. Kurosaki); Department of Cardiology, St. Luke's International Hospital, Chuo, Tokyo, Japan (S.N., K.N.); Division of Cardiology, Kanazawa Cardiovascular Hospital, Ishikawa, Japan (T.T.); and Division of Cardiology, Tsukuba Memorial Hospital, Ibaraki, Japan (M. Igawa).
authors.forename: Taketsugu
authors.initials: T
authors.lastname: Tsuchiya
authors.affiliation: From the Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan (K.M., A.N., K. Kuroki, M. Igarashi, Y.S., K.A.); Department of Heart Rhythm Management, Yokohama Rosai Hospital, Kanagawa, Japan (A.N., Y.K., S.K., K. Kurosaki); Department of Cardiology, St. Luke's International Hospital, Chuo, Tokyo, Japan (S.N., K.N.); Division of Cardiology, Kanazawa Cardiovascular Hospital, Ishikawa, Japan (T.T.); and Division of Cardiology, Tsukuba Memorial Hospital, Ibaraki, Japan (M. Igawa).
authors.forename: Masayuki
authors.initials: M
authors.lastname: Igawa
authors.affiliation: From the Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan (K.M., A.N., K. Kuroki, M. Igarashi, Y.S., K.A.); Department of Heart Rhythm Management, Yokohama Rosai Hospital, Kanagawa, Japan (A.N., Y.K., S.K., K. Kurosaki); Department of Cardiology, St. Luke's International Hospital, Chuo, Tokyo, Japan (S.N., K.N.); Division of Cardiology, Kanazawa Cardiovascular Hospital, Ishikawa, Japan (T.T.); and Division of Cardiology, Tsukuba Memorial Hospital, Ibaraki, Japan (M. Igawa).
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Aonuma
mesh_terms: D000368:Aged; D017115:Catheter Ablation / Q000379:methods*; D017023:Coronary Angiography; D005260:Female; D006801:Humans; D008297:Male; D017202:Myocardial Ischemia / Q000150:complications; D015995:Prevalence; D011690:Purkinje Fibers / Q000503:physiopathology*; D012008:Recurrence; D012189:Retrospective Studies; D017180:Tachycardia, Ventricular / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology*; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000150:complications / Q000503:physiopathology / Q000601:surgery*
keywords: Purkinje fibers; catheter ablation; coronary artery disease; ventricular fibrillation; ventricular tachycardia