[Mapping and ablation of malignant ventricular arrhythmias]

Area of Science:

• Cardiology
• Electrophysiology
• Cardiac Anatomy

Context:

• Ventricular extrasystoles can be challenging to localize and treat.
• The origin of these arrhythmias often dictates therapeutic strategies.

Purpose:

• To investigate the origin of ventricular extrasystoles using endocavitary investigations.
• To evaluate the efficacy of radiofrequency ablation targeting the Purkinje system for treating ventricular extrasystoles and associated ventricular fibrillation.

Summary:

• Endocavitary investigations revealed that most ventricular extrasystoles originate from the Purkinje system (anterior right ventricle or left septal region), with fewer originating from the pulmonary infundibulum.
• Extrasystoles from the Purkinje system and pulmonary infundibulum exhibited distinct durations and morphologies.
• Local Purkinje potentials preceded ventricular activation by variable intervals, sometimes exceeding 150 ms.
• Radiofrequency ablation applied to the distal Purkinje system successfully ablated the specific activation in treated patients.

Impact:

• Radiofrequency ablation targeting the Purkinje system demonstrated a high success rate, with 88% of patients free from ventricular fibrillation episodes.
• This approach offers a promising therapeutic option for managing refractory ventricular arrhythmias originating from the Purkinje system.
• The findings contribute to a better understanding of ventricular arrhythmia mechanisms and ablation strategies.