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Ventricular fibrillation: ablation of a trigger?
Walid Saliba1, Ahmad Abul Karim, Patrick Tchou
1Section of Pacing and Electrophysiology, Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. salibaw@ccf.org
Journal of Cardiovascular Electrophysiology
|January 11, 2003
Summary
Recurrent ventricular fibrillation (VF) in patients without structural heart disease can be triggered by early-coupled premature ventricular contractions. Catheter ablation effectively eliminated this arrhythmia, suggesting a focal trigger mechanism.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Case Reports
Background:
- Recurrent ventricular fibrillation (VF) typically suggests underlying structural heart disease.
- Idiopathic VF, without identifiable cardiac structural abnormalities, presents a diagnostic and therapeutic challenge.
Observation:
- A patient presented with recurrent ventricular fibrillation (VF) despite a structurally normal heart.
- Each episode of VF was consistently preceded by a premature ventricular contraction with identical morphology and early coupling interval.
Findings:
- Standard antiarrhythmic agents were ineffective in suppressing the ventricular ectopy and preventing VF.
- Electrophysiologic testing revealed high-frequency potentials at the earliest activation site, indicative of a focal origin.
- Radiofrequency catheter ablation targeting the focal trigger successfully abolished the premature ventricular contractions and prevented further VF recurrence.
Implications:
- Catheter ablation can be a curative option for ventricular fibrillation originating from focal triggers in patients with structurally normal hearts.
- This case highlights the importance of considering focal triggers in idiopathic recurrent ventricular fibrillation.
- Further research is warranted to determine the prevalence of focal triggers in patients with frequent ventricular ectopy and normal heart structure.