Provocative Cases -> Teaching Case Reports D-PO01 - Featured Poster Session (ID 11) Poster

D-PO01-086 - Alteration Of Wavefront Propagation By Reduction Of Critical Mass Continuity: A Novel Method Of Empiric Mid-purkinje Transection In The Purkinje-mediated Idiopathic Ventricular Fibrillation (ID 81)

 P. Rattanawong: Nothing relevant to disclose.


Background: Idiopathic ventricular fibrillation (IVF) is infrequent mechanism of sudden cardiac arrest (SCA), which is potentially treated by ablating the premature ventricular complex (PVC) that triggers VF. At times, spontaneous or inducible PVC triggering VF may not be reproduced in the electrophysiology lab.
Objective: We report cases of IVF, where triggering PVC could not be identified but were successfully treated by undergoing critical mass continuity reduction using a novel empiric mid-Purkinje transection via radiofrequency ablation.
Results: Three patients initially presented with SCA with documented VF and successful resuscitations. Extensive evaluation was performed and IVF was diagnosed. First two patients underwent empiric mid-Purkinje transection because of non-reproducibility short-coupled PVC triggering VF and last patient because of refractory IVF after failed PVC ablation. Mean age was 48.3±11.6 years old. All patient underwent mid-septal Purkinje fiber transection and empiric linear ablation (red) of Purkinje potentials (black) along left posterior fascicle at distal left ventricular septum. All patients underwent aggressive programmed ventricular stimulation at the end of the procedure, which did not induce any further ventricular arrhythmia. Follow-up ranged from 6 to 52 months and no VF recurrence was documented in all patients.
Conclusion: Critical mass continuity reduction by a novel empiric mid-Purkinje transection radiofrequency ablation may be an effective ablation strategy in IVF patients who have refractory ventricular arrhythmia after failed PVC ablation or non-iducible triggered short-coupled PVC during ablation.