| Autor: |
Xie, Eric, Mayer, Katrina, Capps, Melissa F, Barth, Andreas S, Love, Charles, Coronel, Ruben, Ashikaga, Hiroshi |
| Zdroj: |
Circulation (Ovid); November 2019, Vol. 140 Issue: Supplement 1 pA14747-A14747, 1p |
| Abstrakt: |
Introduction:Ventricular fibrillation (VF) is a functional reentry initiated by unidirectional block in the presence of repolarization heterogeneity combined with an early-coupled premature ventricular complex (PVC). Recently, a subgroup of VF showed repetitive intra-Purkinje activities at fixed anatomical sites, suggestive of a focal mechanism. This VF subgroup is likely amenable to anatomy-based ablation for treatment.Hypothesis:The pattern of VF initiation identifies the subgroup of VF unrelated to functional reentry in implantable cardioverter-defibrillator (ICD) recipients. This VF subgroup is initiated by a PVC occurring after the end of T-wave.Methods:Among 1209 patients with primary and secondary prevention ICD in our remote monitoring clinic, we identified 190 patients who received an ICD therapy (firing or antitachycardia pacing) for VF (n=44), monomorphic ventricular tachycardia (MMVT) (n=134) or both (n=12). Initiation was also quantified by the coupling interval (CI), the cycle length immediately preceding the CI [CL(-1)], and the CI corrected by CL(-1) using Fridericia?s formula (CIc).Results:There was no significant difference in probability density function of CL(-1) between VF and MMVT (p=0.1926; Fig.A). CI in VF was significantly earlier-coupled than that of MMVT (p=0.0213; Fig.B). CIc was significantly different between VF and MMVT (p=0.0021; Fig.C). MMVT showed a mono-modal distribution, which peaks at CIc = 462 msec coinciding with the end of T-wave (black broken line = 450 msec; Fig.C). In contrast, VF showed a bi-modal distribution; one larger subgroup peaks at CIc=392 msec before the end of T-wave, and the other smaller subgroup at CIc=793 msec after the end of T-wave (black arrows).Conclusions:The pattern of VF initiation identifies two separate subgroups of VF with different mechanisms of initiation. This preliminary analysis can be used to further characterize the subgroup to develop a novel therapeutic approach to VF. |
| Databáze: |
Supplemental Index |
| Externí odkaz: |
|
