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

Sites of Successful Ventricular Fibrillation Ablation in Bileaflet Mitral Valve Prolapse Syndrome

“…This transient increased risk of malignant VA was observed when ablating either a Purkinje target or PM, which frequently have Purkinje signals at sites of origin of VA. 27 The marked proarrhythmic effect of radiofrequency ablation of Purkinje tissue has been observed before, 13 including when Purkinje triggers exist at PMs. 18,19 Our current study adds to the understanding of the potential characteristics of proarrhythmia in these patients. Previous studies, including Barlow original description in 1968, have reported on the association of myxomatous MVP with sudden death in the absence of severe MR. [1][2][3][4][5][6]10 Others have demonstrated the association of VA with mitral dysjunction 28 and longer mitral valve leaflets.…”

“…Although none of the patients in this study had delayed enhancement on magnetic resonance imaging before ablation, previous studies of patients with MVP have demonstrated that delayed enhancement consistent with myocardial fibrosis in the region of the mitral subvalvular apparatus is both common and associated with VA. 10,30 The cause for these tissue abnormalities in BiMVPS is currently unknown. It is unlikely that these patients have a coincident, unrelated idiopathic VF with Purkinje triggers amenable to ablation 12,13,19 because consistent localization of VE foci and abnormal tissue with slow conduction to the vicinity of the subvalvular mitral apparatus suggests a structural association. What remains to be fully defined, however, is whether the valvular abnormality is causative, through mechanical trauma from the interaction of mitral leaflet and chordal redundancy with the ventricular cavity, or if there is an associated conduction tissue abnormality 31 or another structural predisposition, such as mitral disjunction.…”

“…Although radiofrequency ablation can be used for VE and VE-triggered ventricular fibrillation (VF), no studies to date have reported on the role of invasive electrophysiological evaluation in patients with BiMVPS. [11][12][13][14][15][16][17][18][19] Thus, we sought to investigate the role and efficacy of electrophysiological study and catheter ablation in patients presenting with BiMVPS.…”

Results of Cryoenergy and Radiofrequency-Based Catheter Ablation for Treating Ventricular Arrhythmias Arising From the Papillary Muscles of the Left Ventricle, Guided by Intracardiac Echocardiography and Image Integration

“…Monomorphic ventricular PVCs originating from the PMs have been found to initiate ventricular fibrillation or polymorphic VT. Catheter ablation of PVC-triggered VF-PMVT is highly successful, 24,25 although recent data show that PVCs originating in the PMs are associated with low radiofrequency ablation success rates (60%), high recurrence rate, long procedure times, and delivery of large amounts of radiofrequency energy. 26 VAs from the right ventricular PMs are less frequent.…”

Conversion to Purkinje-Related Monomorphic Ventricular Tachycardia After Ablation of Ventricular Fibrillation in Ischemic Heart Disease

“…[2][3][4][5][6][7][8][9] Compared with previous studies, the present study has reviewed data regarding more cases of VF ablation in patients with IHD, and collected over a longer follow-up period. To our knowledge, no previous study has analyzed the conversion of VF into monomorphic VT by catheter ablation.…”