Catheter ablation for patients with ventricular fibrillation

Ventricular fibrillation is a challenging arrhythmia for physicians, with only a limited number of treatment options available. Implantable cardioverter defibrillator therapy is the treatment of choice for patients for both primary and secondary prevention with the role of antiarrhythmic therapy aimed at reducing the number of recurrences. Catheter ablation is an accepted treatment for a number of atrial and ventricular arrhythmias, but until recently ventricular fibrillation was thought to be a bridge too far. The recent advances in ventricular fibrillation ablation will be reviewed.

Recent work has demonstrated that the Purkinje network is critical in the triggering and maintenance of ventricular fibrillation. Catheter ablation targeting the ventricular ectopic(s) or Purkinje potentials responsible for triggering ventricular fibrillation or both has been shown to be both possible and efficacious in a number of conditions, ranging from the Brugada syndrome to ischaemic ventricular fibrillation to idiopathic ventricular fibrillation. Although there are relatively few reports of catheter ablation of ventricular fibrillation in the literature, the method appears robust as it is being repeated by a number of different groups around the world.

Catheter ablation targeting ventricular ectopics and Purkinje potentials is a successful treatment for ventricular fibrillation. Although the long-term results of such procedures are awaited, the short-term results are very encouraging.