Conversion to Purkinje-Related Monomorphic Ventricular Tachycardia After Ablation of Ventricular Fibrillation in Ischemic Heart Disease
| Autor: | Kenji Kuroki, Akihiko Nogami, Yuki Komatsu, Masayuki Igawa, Shuzo Nishihara, Kazutaka Aonuma, Kenji Kurosaki, Koichiro Niwa, Yukio Sekiguchi, Miyako Igarashi, Keita Masuda, Shinya Kowase, Taketsugu Tsuchiya |
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| Rok vydání: | 2016 |
| Předmět: |
Male
medicine.medical_specialty Purkinje fibers medicine.medical_treatment Myocardial Ischemia Catheter ablation 030204 cardiovascular system & hematology Coronary Angiography Ventricular tachycardia Purkinje Fibers Coronary artery disease 03 medical and health sciences 0302 clinical medicine Recurrence Interquartile range Physiology (medical) Internal medicine Prevalence medicine Humans 030212 general & internal medicine Aged Retrospective Studies business.industry medicine.disease Ablation Treatment Outcome medicine.anatomical_structure Anesthesia Concomitant Ventricular Fibrillation Ventricular fibrillation Catheter Ablation Tachycardia Ventricular Cardiology Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | Circulation: Arrhythmia and Electrophysiology. 9 |
| ISSN: | 1941-3084 1941-3149 |
| Popis: | Background— 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. Methods and Results— 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. Conclusions— 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. |
| Databáze: | OpenAIRE |
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