Arrhythmias & electrophysiology
Distal-to-Proximal Conduction System Ablation as a Bailout Strategy in Refractory Multi-Exit Purkinje-Related Premature Ventricular Contractions and Ventricular Fibrillation
Authors' conclusion
Distal-to-proximal conduction system ablation can be an effective bailout strategy for patients with refractory multi-exit fascicular/Purkinje-related PVCs and recurrent VF. Larger prospective studies are needed to confirm its long-term safety and efficacy.
Study context
- Population
- Patients with drug-refractory, symptomatic Purkinje premature ventricular contractions (PVCs) who underwent proximal conduction system ablation, with multiple exit sites and morphologiespatients included
- Participants
- 22 patients
- Outcome
- PVC-triggered ventricular fibrillation
Methodological detailsconsecutive patients
- Consecutive patients
Main finding
As reported in the abstract
Patients with PVC-triggered ventricular fibrillation
14
63.6%
Observational data: associations, not effects.
Further findings
Acute elimination of the PVC by distal-to-proximal conduction system ablation
- Acute elimination achieved
- 21 patients (95.5%)
- Procedure discontinued at the patient's request due to the anticipated risk of conduction system injury
- one procedure (4.5%)
Initial site of earliest activation
- Posterior fascicle
- 63.6% (n=14)
- Septal fascicle
- 22.7% (n=5)
- Anterior fascicle
- 13.6% (n=3)
Shift in the site of earliest activation during ablation
- All patients demonstrated a shift in the site of earliest activation
PVC recurrence and recurrent ventricular fibrillation · median follow-up of 32.3 months (IQR 17.5-54.5)
- PVC recurrence requiring repeat ablation
- one patient (4.5%)
- No patient experienced recurrent ventricular fibrillation
Safety
- Conduction disturbances
- 5 patients (22.7%)
Original publication
Summarised from the published abstract; every number is checked against it