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CLINICAL RESEARCH: HEART RHYTHM DISORDER

Role of Purkinje Fibers in Post-Infarction Ventricular Tachycardia

University of Michigan Medical Center, Ann Arbor, Michigan.

Manuscript received June 26, 2006; accepted July 20, 2006.

^_* Reprint requests and correspondence: Dr. Frank Bogun, Assistant Professor of Medicine, Division of Cardiology, University of Michigan Health System, 3119 TC, 1500 East Medical Center Drive, Ann Arbor, Michigan 48109-0366. (Email: fbogun{at}umich.edu).

OBJECTIVES: The objective of this study was to assess the role of Purkinje fibers in monomorphic, post-infarction ventricular tachycardia (VT).

BACKGROUND: Ventricular fibrillation and polymorphic VT in the setting of acute myocardial infarction (MI) may be triggered by ectopy arising from Purkinje fibers.

METHODS: From among a group of 81 consecutive patients with post-infarction monomorphic VT referred for catheter ablation, 9 patients were identified in whom the clinical VT had a QRS duration 145 ms. Mapping was performed focusing on areas with Purkinje potentials.

RESULTS: A total of 11 VTs with a QRS duration 145 ms were induced and mapped in the 9 patients; 9 of the 11 VTs had a right bundle branch block/left-axis morphology that mimicked left posterior fascicular VT. The mean VT cycle length was 402 ± 82 ms. Eight of 9 patients had a history of inferior MI involving the left ventricular septum. One patient had an anterior wall MI with septal involvement. Mapping during VT demonstrated re-entry involving the inferior left ventricular wall. In each of the VTs, a Purkinje potential was present at the exit site of the VT re-entry circuit. Single radiofrequency catheter ablation lesions were successful in eliminating these VTs in all patients.

CONCLUSIONS: The Purkinje system may be part of the re-entry circuit in patients with post-infarction monomorphic VT, resulting in a type of VT with a relatively narrow QRS complex that mimics fascicular VT.

Abbreviations and Acronyms   LV = left ventricle/ventricular   MI = myocardial infarction   VT = ventricular tachycardia

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