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Purkinje and septal substrate modification as a therapeutic option for patients with STEMI and refractory ventricular

Moneeb Khalaph1, Nadica Trajkovska1, Maxim Didenko1

  • 1Department of Electrophysiology, Heart and Diabetes Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany.

Heart Rhythm
|December 24, 2025
PubMed

Insights

Radiofrequency catheter ablation (RFCA) targeting the Purkinje network effectively controlled ventricular fibrillation (VF) in ST-elevation myocardial infarction (STEMI) patients post-percutaneous coronary intervention (PCI). This strategy showed promising long-term outcomes and improved survival.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Interventional Cardiology

Background:

  • Ventricular fibrillation (VF) is a fatal complication post-percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI).
  • Radiofrequency catheter ablation (RFCA) targeting the Purkinje network and septal substrate shows potential for VF treatment, but clinical data are limited.

Purpose of the Study:

  • To evaluate the acute and long-term outcomes of RFCA targeting the Purkinje network and septal substrate in STEMI patients with refractory VF post-PCI.

Main Methods:

  • Prospective, multicenter cohort study of 13 STEMI patients with drug-refractory VF storm despite successful PCI.
  • All patients underwent urgent RFCA with high-density left ventricular mapping and Purkinje-targeted septal substrate modification.
  • The goal was to eliminate spontaneous VF and achieve acute non-inducibility during programmed stimulation.

Main Results:

  • Acute procedural success was achieved in all 13 patients (100%).
  • VF recurrence occurred in only one patient (7.7%) during a median 21-month follow-up, successfully treated with repeat ablation.
  • In-hospital mortality was 15.4% (2/13) due to stroke and sepsis; 15.4% (2/13) experienced procedure-related complete AV block.

Conclusions:

  • Septal substrate modification targeting the Purkinje network is an effective strategy for arrhythmia control in STEMI patients with refractory VF, especially after LAD-STEMI.
  • This approach may improve long-term survival.
  • Further studies are required to confirm these findings.
Abstract

Keywords:
LAD-STEMIPurkinje denetworkingSTEMI-VFSeptal substrate modificationVF ablationVF after STEMI

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