An attempt at electrical catheter ablation of the arrhythmogenic area in idiopathic ventricular fibrillation

Aizawa, Yoshifusa; Tamura, Makoto; Chinushi, Masaomi; Niwano, Shinichi; Kusano, Yoriko; Naitoh, Naoki; Shibata, Akira; Tohjoh, Takehiko; Oeda, Yoshiharu; Joh-o, Kunitaka

doi:10.1016/0002-8703(92)90786-u

Cited by 63 publications

(21 citation statements)

References 6 publications

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“…J wave syndrome has certain characteristics, such as a high association with being male, often occurs during sleep, and has a frequent VF recurrence rate. VPCs were detected just before the occurrence of VF in this patient, and as in the report by Aizawa, et al 5) VPC bigeminy from a left ventricular outflow tract origin was revealed in the 12-lead ECG during the course, but the relationships to the VF events were unknown. We considered catheter ablation therapy targeting the VPCs, but we hesitated because there was no repeatability of the VPCs in the frequent Holter recordings.…”

Section: Discussionsupporting

confidence: 81%

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Early-Morning Type Ventricular Fibrillation With J Wave

et al. 2015

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SummaryA 67-year-old man who had cardiopulmonary arrest (CPA) at home was admitted to our institution. His spontaneous circulation was restored by bystander cardiopulmonary resuscitation (CPR) performed by his wife and an automated external defibrillator (AED). J waves were observed in the inferior leads of an electrocardiogram. We performed an implantable cardioverter defibrillator (ICD) implantation. After the ICD implantation, appropriate shocks due to ventricular fibrillation (VF) were observed on interrogation of the ICD at a frequency of twice a month. Most VF events occurred in the early morning between 1:00 to 6:00, and ventricular premature contractions (VPCs) were detected just before the occurrence of VF. Since the VF events always occurred in the early morning, we started long-acting disopyramide (150 mg/day, before bedtime), which has a muscarinic receptor blocking action. As a result, he has not received any appropriate ICD shocks for more than two years. (Int Heart J 2015; 56: 459-461) Key words: Disopyramide, Idiopathic ventricular fibrillation, J wave syndrome, Implantable cardioverter defibrillator, Ventricular premature contraction V entricular fibrillation (VF) is an arrhythmia that causes sudden cardiac death and can easily occur in patients with structural heart disease. It is well known that VF may occur in patients with a normal heart and J waves on the 12-lead electrocardiogram (ECG). Some studies have reported that J waves on the 12-lead ECG are often detected in healthy subjects with VF events.1-3) In addition, coronary spastic angina (CSA) is also known as a heart disease that causes VF without any structural myocardial injury. Here we present a J wave syndrome patient who had frequent VF events in the early morning showing J waves in the inferior leads of the 12-lead ECG and the VF events were successfully cured by the oral administration of long-acting disopyramide. Case ReportA 67-year-old man who had cardiopulmonary arrest (CPA) at home was admitted to our institution. His spontaneous circulation had been restored by bystander cardiopulmonary resuscitation (CPR) performed by his wife with an automated external defibrillator (AED) (Figure 1). He had no history of previous cardiovascular or other major diseases. Structural heart disease was not detected by echocardiography, but J waves were observed in the inferior leads of the 12-lead ECG (Figure 2). In the 24-hour Holter ECG recording with 12 leads, a circadian variation of the J waves was observed. The J waves were augmented in a lower heart rate, particularly in the early morning. We performed a signal-averaged ECG, but ventricular late potentials were not detected in this case.Blood test results and chest X-rays were normal. In addition, he did not experience any syncopal episodes and did not have a family history of sudden cardiac death. We confirmed that no Brugada-like electrocardiogram pattern was detected using the class Ic antiarrhythmic drug pilsicainide. We performed an electrophysiological study and programmed stimu...

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Section: Discussionsupporting

confidence: 81%

“…In 1992, Aizawa, et al 5) reported that a notch in the late part of the QRS complex was observed in the inferior and V3-5 leads and VPCs can lead to VF. Haïssaguerre, et al 2) described the clinical characteristics of 206 patients resuscitated from VF with J wave syndrome.…”

Section: Discussionmentioning

confidence: 99%

Early-Morning Type Ventricular Fibrillation With J Wave

et al. 2015

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“…Ectopic beats originating from the RVOT and initiating VF may represent one end of a broad clinical spectrum beginning with completely benign, asymptomatic isolated ectopic beats. Table 1 summarizes the reported cases of RVOT VF [12,[14][15][16][17]. The majority of these cases were patients of Japanese origin, and all had similar clinical features and intracardiac mapping findings.…”

Section: Rvot Vfmentioning

confidence: 99%

“…In terms of pharmacologic treatment, class 1A antiarrhythmic drugs have been proposed, because they may prevent reinduction of tachycardia during acute testing [6]. Since some of these patients present with drug-refractory arrhythmia storms resulting in multiple shocks from implanted devices, a curative ablative approach has been attempted by ourselves and others [11][12][13][14][15][16][17][18].…”

Section: Idiopathic Ventricular Fibrillationmentioning

confidence: 99%

“…Reports in the literature describing catheter ablation for idiopathic VF enable us to classify the tachycardia mechanism according to the site of origin of the initiating ectopic beats [11][12][13][14][15][16][17]. Based upon these reports, we make the distinction between RVOT (right ventricular outflow tract) VF and Purkinje-triggered idiopathic VF (Purkinje VF).…”

Section: Idiopathic Ventricular Fibrillationmentioning

confidence: 99%

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Catheter Ablation of Ventricular Fibrillation in Structurally Normal Hearts Targeting the RVOT and Purkinje Ectopy

Weerasooriya

Hsu

Scavée

et al. 2003

Herz

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Catheter ablation for ventricular fibrillation in structurally normal hearts is in its infancy. Recently, catheter ablation of idiopathic ventricular fibrillation as well as ventricular fibrillation associated with the long QT and Brugada syndromes has been described. This review article is a summary of our current understanding of the technique and results of catheter ablation of ventricular fibrillation in structurally normal hearts.

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