Catheter ablation of ventricular fibrillation: importance of left ventricular outflow tract and papillary muscle triggers

Van Herendael, Hugo, Zado, Erica S., Haqqani, Haris, Tschabrunn, Cory M., Callans, David J., Frankel, David S., Lin, David, Garcia, Fermin, Hutchinson, Mathew D., Riley, Michael, Bala, Rupa, Dixit, Sanjay, Yadava, Mrinal and Marchlinski, Francis E. (2014) Catheter ablation of ventricular fibrillation: importance of left ventricular outflow tract and papillary muscle triggers. Heart Rhythm, 11 4: 566-573. doi:10.1016/j.hrthm.2013.12.030


Author Van Herendael, Hugo
Zado, Erica S.
Haqqani, Haris
Tschabrunn, Cory M.
Callans, David J.
Frankel, David S.
Lin, David
Garcia, Fermin
Hutchinson, Mathew D.
Riley, Michael
Bala, Rupa
Dixit, Sanjay
Yadava, Mrinal
Marchlinski, Francis E.
Title Catheter ablation of ventricular fibrillation: importance of left ventricular outflow tract and papillary muscle triggers
Journal name Heart Rhythm   Check publisher's open access policy
ISSN 1547-5271
1556-3871
Publication date 2014-04
Year available 2014
Sub-type Article (original research)
DOI 10.1016/j.hrthm.2013.12.030
Open Access Status
Volume 11
Issue 4
Start page 566
End page 573
Total pages 8
Place of publication Philadelphia, United States
Publisher Elsevier
Collection year 2015
Language eng
Formatted abstract
Background: Monomorphic ventricular premature depolarizations (VPDs) have been found to initiate ventricular fibrillation (VF) or polymorphic ventricular tachycardia (PMVT) in patients with and without structural heart disease.

Objective: The purpose of this study was to describe and characterize sites of origin of VPDs triggering VF and PMVT. Methods: The distribution of mapping-confirmed VPDs, electrophysiology laboratory findings, and results of radiofrequency catheter ablation were analyzed.

Results: Among 1132 consecutive patients who underwent ablation for ventricular arrhythmias, 30 patients (2.7%) with documented VF/PMVT initiation were identified. In 21 patients, VF/PMVT occurred in the setting of cardiomyopathy; in 9 patients, VF/PMVT was idiopathic. The origin of VPD trigger was from the Purkinje network in 9, papillary muscles in 8, left ventricular outflow tract in 9, and other low-voltage areas unrelated to Purkinje activity in 4. Each distinct anatomic area of origin was associated with VF/PMVT triggers in patients with and without heart disease. Acute VPD elimination was achieved in 26 patients (87%), with a decrease in VPDs in another 3 patients (97%). During median follow-up of 418 days (interquartile range [IQR] 144-866), 5 patients developed a VF/PMVT recurrence after a median of 34 days (IQR 1-259). Rare recurrence was noted in patients with and without structural disease and from each distinct anatomic origin. The total burden of VF/PMVT episodes/shocks was reduced from a median of 9 (IQR 2.5-22.5) in the 3 months before ablation to 0 (IQR 0-0, total range 0-2) during follow-up (P <.0001).

Conclusion: Catheter ablation of VPD-triggered VF/PMVT is highly successful. Left ventricular outflow tract and papillary muscles are common and are previously unrecognized sites of origin of these triggers in patients with and without structural heart disease.
Keyword Catheter ablation
Outflow tract
Papillary muscle
Ventricular fibrillation
Ventricular premature depolarization
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2015 Collection
School of Medicine Publications
 
Versions
Version Filter Type
Citation counts: TR Web of Science Citation Count  Cited 18 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 24 times in Scopus Article | Citations
Google Scholar Search Google Scholar
Created: Tue, 15 Apr 2014, 01:24:34 EST by System User on behalf of School of Medicine