Imnadze Guram, Zerm Thomas
Heart and Diabetes Center North Rhine-Westphalia, Clinic of Arrhythmia Magnagement, Bad Oeynhausen, Nordrhein-Westfalen, DE.
Ruhr-Universitat Bochum Medizinische Fakultat, Arrhythmia Management, Bochum, Nordrhein-Westfalen, DE.
Pacing Clin Electrophysiol. 2019 Oct;42(10):1285-1290. doi: 10.1111/pace.13782. Epub 2019 Sep 3.
Sudden cardiac death from ventricular fibrillation (VF) remains a major health problem worldwide. Currently, there are limited treatment options available to patients who suffer from episodes of VF. Because Purkinje fibers have been implicated as a source of initiation of VF, we are presenting the first paper of a series highlighting the promising results of substrate modulation through "De-Networking" of the Purkinje system preventing VF in patients without an alternative ablation strategy.
We studied 10 consecutive patients (two female) all but one implanted with an ICD with documented VF or fast polymorphic Ventricular tachycardia (VT) (five patients without history of structural heart disease, two with ischemic cardiomyopathy, one with hypertrophic obstructive cardiomyopathy, one with dilated cardiomyopathy, and one with aortic valve disease). After 3D electroanatomical mapping, the left bundle branch (LBB) and left ventricular Purkinje potentials were annotated creating a virtual triangle with the apex formed by the distal LBB and the base by the most distal Purkinje potentials. Linear radiofrequency catheter ablation at the base of the triangle was performed, followed by ablation within the virtual triangle sparing the LBB and both fascicles ("de-networking"). All patients were treated without complications. During 1-year follow-up, only 2/10(20%) patients experienced recurrence in form of a single episode of polymorphic VT/VF.
Catheter ablation of VF through "de-networking" of the Purkinje system in patients without overt arrhythmia substrate or trigger appears safe and effective and will require further study in a larger patient cohort.
心室颤动（VF）导致的心脏性猝死仍是全球主要的健康问题。目前，对于发生VF的患者，可用的治疗选择有限。由于浦肯野纤维被认为是VF起始的一个来源，我们正在发表一系列论文中的第一篇，重点介绍通过对浦肯野系统进行“去网络化”来调节基质，从而在没有其他消融策略的患者中预防VF的有前景的结果。
我们研究了连续10例患者（2例女性），除1例患者外，其余均植入了植入式心律转复除颤器（ICD），并有记录的VF或快速多形性室性心动过速（VT）（5例无结构性心脏病史，2例患有缺血性心肌病，1例患有肥厚性梗阻性心肌病，1例患有扩张型心肌病，1例患有主动脉瓣疾病）。在进行三维电解剖标测后，对左束支（LBB）和左心室浦肯野电位进行标注，形成一个虚拟三角形，其顶点由LBB远端形成，底边由最远端的浦肯野电位形成。在三角形底边进行线性射频导管消融，随后在虚拟三角形内进行消融，避开LBB和两个束支（“去网络化”）。所有患者治疗过程均无并发症。在1年的随访期间，只有2/10（20%）的患者以单次多形性VT/VF发作的形式复发。
对于没有明显心律失常基质或触发因素的患者，通过对浦肯野系统进行“去网络化”来消融VF似乎是安全有效的，需要在更大的患者队列中进行进一步研究。
