Arrhythmias & electrophysiologyCohort study
Trigger- vs Substrate-Based Purkinje De-Networking for Ventricular Fibrillation
- retrospective multicenter cohort
Authors' conclusion
Substrate-based de-networking was associated with greater freedom from ventricular tachycardia/VF but a higher rate of conduction system injury. Trigger-focused ablation may serve as an initial strategy in patients with identifiable premature ventricular complex triggers, with substrate modification reserved for refractory or nontriggered VF.
Study context
- Population
- Patients undergoing Purkinje-targeted ventricular fibrillation (VF) ablation using high-power, short-duration radiofrequency energy (90 W for 4 seconds or 50 W for 10 seconds)patients who underwent Purkinje-targeted VF ablation
- Participants
- 43 patients
- Exposure
- trigger-focused and substrate-based Purkinje de-networking for VF
- trigger groupn = 19reference
- substrate groupn = 24
- Outcome
- Recurrence of polymorphic ventricular tachycardia/VF (reported as freedom from polymorphic ventricular tachycardia/VF)
- Follow-up
- Median 12.2 months (Q1-Q3: 8.8-18.8 months)
Main finding
As reported in the abstract
Hazard ratio
0.20
95% CI 0.05–0.76
P = 0.026
Events by group
Observational data: associations, not effects.
Secondary outcomes
| Outcome | trigger group | substrate group |
|---|---|---|
| Arrhythmic burden | 3.9 ± 0.8 episodes to 0.4 ± 0.2 episodes episodes | 4.8 ± 1.2 episodes to 0.1 ± 0.1 episodes episodes |
- Arrhythmic burden: trigger group P < 0.001
- Arrhythmic burden: substrate group P < 0.001
Arrhythmic burden
- Both approaches significantly reduced arrhythmic burden
Baseline characteristics
- Baseline characteristics were similar between groups
Safety
Conduction complications
new left bundle branch block substrate group 5 of 24 (20.8%)
posterior fascicular block trigger group 1 of 19 (5.3%)
- Conduction complications: P < 0.001
Original publication
Summarised from the published abstract; every number is checked against it