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CLINICAL RESEARCH: HEART RHYTHM DISORDER

Long-Term Follow-Up of Idiopathic Ventricular Fibrillation Ablation

A Multicenter Study

Sébastien Knecht, MD^_*,,_*, Frédéric Sacher, MD^_*, Matthew Wright, MBBS, PhD^_*, Mélèze Hocini, MD^_*, Akihiko Nogami, MD, Thomas Arentz, MD, Bertrand Petit, MD, Robert Franck, MD^||, Christian De Chillou, MD^¶, Dominique Lamaison, MD^#, Jéronimo Farré, MD^_**, Thomas Lavergne, MD, Thierry Verbeet, MD, Isabelle Nault, MD^_*, Seiichiro Matsuo, MD^_*, Lionel Leroux, MD^_*, Rukshen Weerasooriya, MD^_*, Bruno Cauchemez, MD, Nicolas Lellouche, MD^_*, Nicolas Derval, MD^_*, Sanjiv M. Narayan, MD, PhD^_*, Pierre Jaïs, MD^_*, Jacques Clementy, MD^_* and Michel Haïssaguerre, MD^_*

^_* Hôpital Cardiologique du Haut-Lévêque and the Université Victor Segalen Bordeaux II, Bordeaux, France
Yokohama Rosai Hospital, Yokohama, Japan
Herz-Zentrum, Bad Krozingen, Germany
Centre hospitalier Sud Réunion, Saint Pierre, France
^|| Hôpital de la Pitié-Salpêtrière, Paris, France
^¶ CHU of Nancy, Nancy, France (CdC)
^# CHU of Clermond-Ferrand, Clermond-Ferrand, France
^_** Fundacion Jimenez Diaz, Madrid, Spain
CHU de Paris, Paris, France
CHU Brugmann, Brussels, Belgium
Lariboisière Hospital, Paris, France

Manuscript received December 8, 2008; revised manuscript received February 20, 2009, accepted March 3, 2009.

^_* Reprint requests and correspondence: Dr. Sébastien Knecht, Service de Rythmologie, Hôpital Cardiologique du Haut-Lévêque, Avenue de Magellan, 33604 Bordeaux-Pessac, France (Email: sebastien.knecht{at}chu-brugmann.be).

Objectives: This multicenter study sought to evaluate the long-term follow-up of patients ablated for idiopathic ventricular fibrillation (VF).

Background: Catheter ablation of idiopathic VF that targets ventricular premature beat (VPB) triggers has been shown to prevent VF recurrences on short-term follow-up.

Methods: From January 2000, 38 consecutive patients from 6 different centers underwent ablation of primary idiopathic VF initiated by short coupled VPB. All patients had experienced at least 1 documented VF, with 87% having experienced 2 VF episodes in the preceding year. Catheter ablation was guided by activation mapping of VPBs or pace mapping during sinus rhythm.

Results: There were 38 patients (21 men) age 42 ± 13 years, refractory to a median of 2 antiarrhythmic drugs. Triggering VPBs originated from the right (n = 16), the left (n = 14), or both (n = 3) Purkinje systems and from the myocardium (n = 5). During a median post-procedural follow-up of 63 months, 7 (18%) of 38 patients experienced VF recurrence at a median of 4 months. Five of these 7 patients underwent repeat ablation without VF recurrence. Survival free of VF was predicted only by transient bundle-branch block in the originating ventricle during the electrophysiological study (p < 0.0001). The number of significant events (confirmed VF or aborted sudden death) was reduced from 4 (interquartile range 3 to 9) before to 0 (interquartile range 0 to 4) after ablation (p = 0.01).

Conclusions: Ablation for idiopathic VF that targets short coupled VPB triggers is associated with a long-term freedom from VF recurrence.

Key Words: ventricular fibrillation • ablation • mapping • purkinje • ventricular premature beat • trigger

Abbreviations and Acronyms   ICD = implantable cardiac-defibrillator   IQR = interquartile range   VF = ventricular fibrillation   VPB = ventricular premature beat   VT = ventricular tachycardia

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