Role of Purkinje conducting system in triggering of idiopathic ventricular fibrillation

Haı̈ssaguerre, Michel; Shah, Dipen; Jaı̈s, Pierre; Shoda, Morio; Kautzner, Josef; Arentz, Thomas; Kalushe, Dietrich; Kadish, Alan H.; Griffith, Mike; Gaïta, Fiorenzo; Yamane, Teiichi; Garrigue, Stéphane; Hocini, Mélèze; Clémenty, Jacques

doi:10.1016/s0140-6736(02)07807-8

Cited by 330 publications

(228 citation statements)

References 3 publications

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“…Currently, there is no cure for VF, with only rudimentary treatment options available; thus, sudden cardiac death from VF remains a major worldwide health problem 3, 4. The Purkinje system is implicated in the genesis of primary VF,5, 6, 7 with radiofrequency ablation successfully treating this lethal arrhythmia by targeting triggers, such as a premature ventricular beat emanating from Purkinje tissue 7, 8, 9, 10. However, current radiofrequency ablation approaches to the Purkinje fibers have limitations, particularly because they can only be applied in a point‐to‐point manner, which is tedious and time‐consuming.…”

mentioning

confidence: 99%

Elimination of Purkinje Fibers by Electroporation Reduces Ventricular Fibrillation Vulnerability

Livia

Sugrue

Witt

et al. 2018

JAHA

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BackgroundThe Purkinje network appears to play a pivotal role in the triggering as well as maintenance of ventricular fibrillation. Irreversible electroporation (IRE) using direct current has shown promise as a nonthermal ablation modality in the heart, but its ability to target and ablate the Purkinje tissue is undefined. Our aim was to investigate the potential for selective ablation of Purkinje/fascicular fibers using IRE.Methods and ResultsIn an ex vivo Langendorff model of canine heart (n=8), direct current was delivered in a unipolar manner at various dosages from 750 to 2500 V, in 10 pulses with a 90‐μs duration at a frequency of 1 Hz. The window of ventricular fibrillation vulnerability was assessed before and after delivery of electroporation energy using a shock on T‐wave method. IRE consistently eradicated all Purkinje potentials at voltages between 750 and 2500 V (minimum field strength of 250–833 V/cm). The ventricular electrogram amplitude was only minimally reduced by ablation: 0.6±2.3 mV (P=0.03). In 4 hearts after IRE delivery, ventricular fibrillation could not be reinduced. At baseline, the lower limit of vulnerability to ventricular fibrillation was 1.8±0.4 J, and the upper limit of vulnerability was 19.5±3.0 J. The window of vulnerability was 17.8±2.9 J. Delivery of electroporation energy significantly reduced the window of vulnerability to 5.7±2.9 J (P=0.0003), with a postablation lower limit of vulnerability=7.3±2.63 J, and the upper limit of vulnerability=18.8±5.2 J.ConclusionsOur study highlights that Purkinje tissue can be ablated with IRE without any evidence of underlying myocardial damage.

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mentioning

confidence: 99%

Elimination of Purkinje Fibers by Electroporation Reduces Ventricular Fibrillation Vulnerability

Livia

Sugrue

Witt

et al. 2018

JAHA

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“…The role of Purkinje fibers in the initiation and maintenance of ventricular fibrillation is increasingly recognized. 109,110 Purkinje fibers create distinct high-frequency electrograms due to their fast action potential upstroke. While conventional electrogram processing systems can display Purkinje potentials, it is difficult to visualize these consistently.…”

Section: Novel Targets For Catheter Ablationmentioning

confidence: 99%

Innovations in Clinical Cardiac Electrophysiology: Challenges and Upcoming Solutions in 2018 and Beyond

Vaidya¹,

Sugure²,

Asirvatham³

2017

J Innov Cardiac Rhythm Manage

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“…Haïssaguerre 2, 3. His hypothesis is that Purkinje fibers can be the originator of malignant arrhythmias such as “idiopathic” ventricular fibrillation on healthy heart (normal physical examination, normal ECG, normal stress test, normal coronary angiography, normal left and right ventricular function, and exclusion long QT or Brugada).…”

Section: Clinical Casementioning

confidence: 99%

Night syncope: a case report

Loumaye

Blommaert

2016

Clinical Case Reports

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Role of Purkinje conducting system in triggering of idiopathic ventricular fibrillation

Cited by 330 publications

References 3 publications

Elimination of Purkinje Fibers by Electroporation Reduces Ventricular Fibrillation Vulnerability

Elimination of Purkinje Fibers by Electroporation Reduces Ventricular Fibrillation Vulnerability

Innovations in Clinical Cardiac Electrophysiology: Challenges and Upcoming Solutions in 2018 and Beyond

Night syncope: a case report

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