Multifocal Ventricular Arrhythmias Originating From the His-Purkinje System: Incidence, Characteristics, and Outcome of Catheter Ablation

JACC. Clinical Electrophysiology
Taihei Itoh, Takumi Yamada

Abstract

This study sought to reveal the characteristics and radiofrequency catheter ablation (RFCA) outcomes of multifocal His-Purkinje system (HPS) ventricular arrhythmias (VAs). The details of those VAs, especially the safety and efficacy of their RFCA treatment, remain unclear. Thirty consecutive patients who underwent RFCA of focal HPS VAs between 2010 and 2016 (unifocal = 24, multifocal = 6) were studied by measuring the electrophysiological variables within the HPS. Multifocal premature ventricular contractions (n = 1) and ventricular fibrillation (VF) (n = 5) were identified in the left posterior (n = 6), anterior (n = 4), and septal fascicles (n = 1), as well as the basal left bundle branch (LBB) (n = 2) and right bundle branch (RBB) (n = 2). In 2 patients with unifocal VAs and 4 patients with multifocal VAs, preferential conduction from an origin within the proximal fascicle (n = 4) or LBB (n = 2) to ≤3 breakout sites in the distal fascicles occurred with split or fractionated Purkinje potentials and/or conduction block at the site of origin. Among the multifocal VAs, 11 fascicle VAs, 1 RBB VA, and 1 LBB VA were successfully ablated with fascicular and/or bundle branch block, and complete atrioventricular block (CAVB), respect...Continue Reading

References

Aug 21, 2002·Circulation·Michel HaïssaguerreJacques Clémenty
Mar 19, 2004·Journal of Cardiovascular Electrophysiology·Gustavo LoperaLaurence M Epstein
Sep 21, 2005·Heart Rhythm : the Official Journal of the Heart Rhythm Society·Ernest W LauMichael J Griffith
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Dec 3, 2014·Journal of Cardiovascular Electrophysiology·Samuel J Asirvatham
Aug 30, 2016·Journal of Cardiovascular Electrophysiology·Rajeev K PathakSanjay Dixit

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Citations

Feb 26, 2021·Annals of Noninvasive Electrocardiology : the Official Journal of the International Society for Holter and Noninvasive Electrocardiology, Inc·Songwen ChenShaowen Liu

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