Idiopathic ventricular fibrillation with repetitive activity inducible within the distal Purkinje system

Haı̈ssaguerre, Michel; Cheniti, Ghassen; Escande, William; Zhao, Alexandre; Hocini, Mélèze; Bernus, Olivier

doi:10.1016/j.hrthm.2019.04.012

Cited by 22 publications

(11 citation statements)

References 15 publications

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“…In those events, the mechanism of VF is unlikely to be re‐entry initiated by a single PVC but rather by a train of multiple PVC or nonsustained VT of short CL, which comprise the initial several beats of what appears to be VF. In fact, this finding is consistent with a recent report that a subgroup of VF is caused by repetitive intra‐Purkinje activities at fixed anatomical sites 29 . Although this finding does not necessarily change the therapeutic approach to VF from a device or an ablation perspective, it has significant mechanistic implications.…”

Section: Discussionsupporting

confidence: 91%

Mechanism of spontaneous initiation of ventricular fibrillation in patients with implantable defibrillators

Xie

Mayer

Capps

et al. 2020

Cardiovasc electrophysiol

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Introduction To improve the mechanistic understanding of spontaneous initiation of ventricular fibrillation (VF), we characterized the patterns of premature ventricular complex (PVC) preceding spontaneous VF in primary and secondary implantable cardioverter‐defibrillator (ICD) recipients. Methods and Results A single‐center, cross‐sectional analysis of 1209 patients with primary and secondary prevention ICD identified 190 patients who received ICD therapy (firing or antitachycardia pacing) for VF or monomorphic ventricular tachycardia (MMVT). Initiation was quantified by the coupling interval (CI), the cycle length immediately preceding the CI (CL(−1)), the CI corrected by CL(−1) using Fridericia's formula (CIc), and the prematurity index (PI). In both VF (n = 44; 23%) and MMVT (n = 134; 71%), the most common pattern of initiation was late‐coupled PVC, followed by the short‐long‐short pattern. The parameters such as pre‐initiation median CL, CL(−1), CI, and PI were not significantly different between VF and MMVT for any patterns. At least some events (45% of VF and 63% of MMVT) had extremely long CIs beyond the QTc cut‐off estimated from the CL(−1), suggestive of initiation by a train of multiple PVCs or nonsustained VT instead of a single PVC. Conclusion Some spontaneous VF events in ICD recipients appear to be initiated by a train of multiple PVC or nonsustained VT rather than a single PVC. This finding indicates that patterns of a single PVC are not an important determinant of VF initiation and thus account for conflicting results in previous studies.

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Section: Discussionsupporting

confidence: 91%

Mechanism of spontaneous initiation of ventricular fibrillation in patients with implantable defibrillators

Xie

Mayer

Capps

et al. 2020

Cardiovasc electrophysiol

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“… 2 IVF is a rare cause of sudden death, with an incidence between 1.2% and 6.8%. 3 Haissaguerre and colleagues 4 demonstrated that repetitive activity from the distal Purkinje fiber network may cause VF even with minimal or no PVCs at baseline. Quinidine is a class Ia sodium channel blocker that also reduces the inward and outward potassium currents IK1 and IK to .…”

Section: Discussionmentioning

confidence: 99%

The case for quinidine: Management of electrical storm in refractory ventricular fibrillation

Pinnelas

Friedman

Gidea

et al. 2020

HeartRhythm Case Reports

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“…The specialized Purkinje system constitutes a tiny part (about 2%) of the myocardial mass, but its pathologic role in arrhythmogenesis is disproportionally high and pleomorphic. 16,17 Purkinje pathology in IVF can manifest either as triggering ectopies or as arrhythmia maintenance via its complex network.…”

Section: Pathology Of the Purkinje System In Idiopathic Ventricular Fmentioning

confidence: 99%

The Spectrum of Idiopathic Ventricular Fibrillation and J-Wave Syndromes

Haı̈ssaguerre

Nademanee

Hocini

et al. 2019

Cardiac Electrophysiology Clinics

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Idiopathic ventricular fibrillation (IVF) is defined as unexplained sudden cardiac death due to ventricular fibrillation (VF) without any identifiable structural or electrical cause after extensive investigations (no phenotype). Recent data show that the use of high-density electrophysiologic mapping may ultimately offer subclinical diagnoses of cardiac disease in about 90% of individuals with IVF. Two major conditions underlie the occurrence of VF: the presence of either depolarization abnormalities due to microstructural myocardial alteration or Purkinje abnormalities manifesting as triggering ectopy or reentry in the peripheral network. J-wave syndromes are defined as a distinct electrocardiographic phenotype (slurring/notch) affecting the junction between the QRS complex and the ST segment in inferolateral leads. Recent data provide evidence for heterogeneous substrates, related to either delayed depolarization due to microstructural alterations or early repolarization abnormalities. IVF and J-wave syndromes are the result of a wide spectrum of pathophysiologic processes. The individual phenotypic characterization is essential given its implications in therapy, genetic testing, and risk stratification.

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Idiopathic ventricular fibrillation with repetitive activity inducible within the distal Purkinje system

Cited by 22 publications

References 15 publications

Mechanism of spontaneous initiation of ventricular fibrillation in patients with implantable defibrillators

Mechanism of spontaneous initiation of ventricular fibrillation in patients with implantable defibrillators

The case for quinidine: Management of electrical storm in refractory ventricular fibrillation

The Spectrum of Idiopathic Ventricular Fibrillation and J-Wave Syndromes

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