Objective
We mapped human ventricular fibrillation (VF) to define mechanistic differences between episodes requiring defibrillation versus those that spontaneously terminate.
Background
VF is a leading cause of mortality, yet episodes may also self-terminate. We hypothesized that the initial maintenance of human VF is dependent upon the formation and stability of VF rotors.
Methods
We enrolled 26 consecutive patients (age 64±10 years, n=13 with LV dysfunction) during ablation procedures for ventricular arrhythmias, using 64-electrode basket catheters in both ventricles to map VF prior to prompt defibrillation per IRB-approved protocol. Fifty-two inductions were attempted and 36 VF episodes were observed. Phase analysis was applied to identify bi-ventricular rotors in the first 10 seconds or until VF terminated, whichever came first (11.4±2.9 seconds to defibrillator charging).
Results
Rotors were present in 16 of 19 patients with VF, and in all patients with sustained VF. Sustained, but not self-limiting VF, was characterized by greater rotor stability: (1) rotors were present in 68±17% of cycles in sustained versus 11±18% of cycles in self-limiting VF (p<0.001); with (2) maximum continuous rotations greater in sustained (17±11, range 7–48) versus self-limiting VF (1.1±1.4, range 0–4, p<0.001). Additionally, biventricular rotor locations in sustained VF were conserved across multiple inductions (7/7 patients, p=0.025).
Conclusions
In patients with and without structural heart disease, the formation of stable rotors identifies individuals whose VF requires defibrillation from those in whom VF spontaneously self-terminates. Future work should define the mechanisms that stabilize rotors and evaluate whether rotor modulation may reduce subsequent VF risk.
Introduction
Electrical storm is a condition characterized by multiple episodes of ventricular tachycardia (VT) or ventricular fibrillation (VF) in a short period of time.
Case Presentation
An 80-year-old male with a history of ischemic cardiomyopathy presented with multiple ICD shocks. As a last resort, he underwent percutaneous left, followed by right, stellate ganglion block under fluoroscopic guidance. Since his discharge, he has been managed with alternating, biweekly left and right stellate ganglion blocks, and he has received no ICD shocks.
Discussion
This case illustrates the potential of ongoing, temporary percutaneous stellate ganglion blockade in suppressing ventricular arrhythmogenesis.
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