Long-Term Follow-Up of Idiopathic Ventricular Fibrillation AblationA 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
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Figure 1 Triggered VF
Twelve-lead electrocardiograms (left) and their corresponding location in the anteroposterior fluoroscopic view (right, red asterisks). The origin of ventricular premature beat (VPB) triggering ventricular fibrillation (VF) was the left Purkinje either at the posterior (A) or the anterior (B) insertion, the right Purkinje (C), and the right ventricular outflow track (D). Related fluoroscopic views with a decapolar catheter inserted in the left ventricle (E and F), an ablation catheter inserted in the right ventricle (G), and a quadripolar catheter inserted at the His position (E to G). Ventricular premature beat originating in the left Purkinje system (A and B and related anteroposterior fluoroscopic view) produce more variable 12-lead electrocardiogram (ECG) patterns, reflecting the more complex and extended Purkinje arborization on the left. VPBs originating in the right Purkinje system (C and related anteroposterior fluoroscopic view) typically have a left bundle-branch block pattern with left superior axis. Ventricular premature beat originating from the right ventricular outflow track (D) have the classical aspect with a left bundle-branch block pattern and an inferior axis.
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Figure 2 12-Lead Electrocardiogram During Radiofrequency Ablation at the Right Purkinje System
The start of ablation (arrow) typically resulted in ventricular tachycardia followed by sinus rhythm, as shown in this example.
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Figure 3 Example of a Mechanical Trauma "Bumping" of the Right Bundle-Branch Before Ablation
A mechanical trauma "bumping" of the right bundle branch results in a typical right bundle-branch pattern on the 12-lead electrocardiogram and the disappearance of the Purkinje potential (asterisks), which is activated retrogradely and therefore obscured by the ventricular complex. The third QRS complex is indicted by the arrow.
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