Successful Substrate Ablation for Ventricular Fibrillation in a Patient With Nonischemic Cardiomyopathy

Abstract

A 58-year-old woman with nonischemic cardiomyopathy underwent an ablation for refractory ventricular fibrillation (VF). In addition to elimination of the premature ventricular contraction triggering VF, substrate ablation entailed elimination of dormant Purkinje potentials, which were unmasked in regions where local pacing revealed a narrow QRS with stimulus QRS latency. VF trigger and abnormal Purkinje ablation completely eliminated the refractory VF. ( Level of Difficulty: Intermediate. )

Emergency Management of Electrical Storm: A Practical Overview

“…Usually, ES occurs in conditions of elevated sympathetic tone, but sometimes even parasympathetic tone might be involved. Focal excitation due to abnormal automaticity or triggered activity might become a trigger that initiates or maintain reentrant VT. Purkinje fibers are considered possible trigger sources for polymorphic VT or VF storm in patients with MI [ 25 ] and HF [ 26 ], and they might be susceptible to CA [ 27 ].…”