Catheter ablation of ventricular fibrillation

Importance of left ventricular outflow tract and papillary muscle triggers

Hugo Van Herendael, Erica S. Zado, Haris Haqqani, Cory M. Tschabrunn, David J. Callans, David S. Frankel, David Lin, Fermin Garcia, Mathew D. Hutchinson, Michael Riley, Rupa Bala, Sanjay Dixit, Mrinal Yadava, Francis E. Marchlinski

Research output: Contribution to journalArticle

51 Citations (Scopus)

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

Original languageEnglish (US)
Pages (from-to)566-573
Number of pages8
JournalHeart Rhythm
Volume11
Issue number4
DOIs
StatePublished - 2014
Externally publishedYes

Fingerprint

Catheter Ablation
Papillary Muscles
Ventricular Fibrillation
Ventricular Tachycardia
Heart Diseases
Recurrence
Electrophysiology
Cardiomyopathies
Cardiac Arrhythmias
Shock

Keywords

  • Catheter ablation
  • Outflow tract
  • Papillary muscle
  • Ventricular fibrillation
  • Ventricular premature depolarization

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)
  • Medicine(all)

Cite this

Van Herendael, H., Zado, E. S., Haqqani, H., Tschabrunn, C. M., Callans, D. J., Frankel, D. S., ... Marchlinski, F. E. (2014). Catheter ablation of ventricular fibrillation: Importance of left ventricular outflow tract and papillary muscle triggers. Heart Rhythm, 11(4), 566-573. https://doi.org/10.1016/j.hrthm.2013.12.030

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; Marchlinski, Francis E.

In: Heart Rhythm, Vol. 11, No. 4, 2014, p. 566-573.

Research output: Contribution to journalArticle

Van Herendael, H, Zado, ES, Haqqani, H, Tschabrunn, CM, Callans, DJ, Frankel, DS, Lin, D, Garcia, F, Hutchinson, MD, Riley, M, Bala, R, Dixit, S, Yadava, M & Marchlinski, FE 2014, 'Catheter ablation of ventricular fibrillation: Importance of left ventricular outflow tract and papillary muscle triggers', Heart Rhythm, vol. 11, no. 4, pp. 566-573. https://doi.org/10.1016/j.hrthm.2013.12.030
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. / Catheter ablation of ventricular fibrillation : Importance of left ventricular outflow tract and papillary muscle triggers. In: Heart Rhythm. 2014 ; Vol. 11, No. 4. pp. 566-573.
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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",
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T1 - Catheter ablation of ventricular fibrillation

T2 - Importance of left ventricular outflow tract and papillary muscle triggers

AU - Van Herendael, Hugo

AU - Zado, Erica S.

AU - Haqqani, Haris

AU - Tschabrunn, Cory M.

AU - Callans, David J.

AU - Frankel, David S.

AU - Lin, David

AU - Garcia, Fermin

AU - Hutchinson, Mathew D.

AU - Riley, Michael

AU - Bala, Rupa

AU - Dixit, Sanjay

AU - Yadava, Mrinal

AU - Marchlinski, Francis E.

PY - 2014

Y1 - 2014

N2 - 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

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KW - Ventricular premature depolarization

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