Cheniti Ghassen, Vlachos Konstantinos, Meo Marianna, Puyo Stephane, Thompson Nathaniel, Denis Arnaud, Duchateau Josselin, Takigawa Masateru, Martin Claire, Frontera Antonio, Kitamura Takeshi, Lam Anna, Bourier Felix, Klotz Nicolas, Derval Nicolas, Sacher Frederic, Jais Pierre, Dubois Remi, Hocini Meleze, Haissaguerre Michel
Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.
IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France.
Front Cardiovasc Med. 2018 Sep 18;5:123. doi: 10.3389/fcvm.2018.00123. eCollection 2018.
Idiopathic ventricular fibrillation (IVF) is the main cause of unexplained sudden cardiac death, particularly in young patients under the age of 35. IVF is a diagnosis of exclusion in patients who have survived a VF episode without any identifiable structural or metabolic causes despite extensive diagnostic testing. Genetic testing allows identification of a likely causative mutation in up to 27% of unexplained sudden deaths in children and young adults. In the majority of cases, VF is triggered by PVCs that originate from the Purkinje network. Ablation of VF triggers in this setting is associated with high rates of acute success and long-term freedom from VF recurrence. Recent studies demonstrate that a significant subset of IVF defined by negative comprehensive investigations, demonstrate in fact subclinical structural alterations. These localized myocardial alterations are identified by high density electrogram mapping, are of small size and are mainly located in the epicardium. As reentrant VF drivers are often colocated with regions of abnormal electrograms, this localized substrate can be shown to be mechanistically linked with VF. Such areas may represent an important target for ablation.
特发性室颤（IVF）是不明原因心源性猝死的主要原因，尤其是在35岁以下的年轻患者中。IVF是在经过广泛诊断检查后，无任何可识别的结构或代谢原因而从室颤发作中存活下来的患者的排除性诊断。基因检测能够在高达27%的儿童和年轻成人不明原因猝死中识别出可能的致病突变。在大多数情况下，室颤由起源于浦肯野网络的室性早搏触发。在此情况下，消融室颤触发因素与较高的急性成功率和室颤长期不复发相关。最近的研究表明，经全面检查为阴性所定义的IVF的一个重要亚组，实际上存在亚临床结构改变。这些局部心肌改变通过高密度心电图标测得以识别，其范围较小，主要位于心外膜。由于折返性室颤驱动因素常与异常心电图区域共存，这种局部基质可被证明在机制上与室颤相关。这些区域可能是消融的重要靶点。
