The Lead Episode 71: A Discussion of Fascicular Substrate Modification to Treat Human Ventricular Fibrillation-JACC Electrophysiology (visual aid)

JACC Electrophysiology (visual aid)

Pdf Summary

A study investigated catheter-based fascicular substrate modification (FSM) to treat ventricular fibrillation (VF) and polymorphic ventricular tachycardia (PMVT) in 18 patients out of 2,212 with ventricular arrhythmia. High-density mapping identified Purkinje fibers during sinus rhythm, with an ablation endpoint of noninducibility of VF and PMVT. Results showed a 88.9% arrhythmia-free rate after a median 24-month follow-up, with higher success in idiopathic VF cases. FSM was performed by targeting abnormal Purkinje potentials, leading to eradication without inducing new conduction block or bundle branch block. No procedure-related complications were reported. The study highlighted the role of Purkinje fibers in VF initiation and showed that FSM is feasible, safe, and highly effective in preventing recurrent VF in the long term. The approach involved detailed mapping and targeted ablation of abnormal Purkinje potentials. Patients with underlying cardiomyopathy had a slightly higher recurrence rate compared to those without cardiomyopathy. Larger randomized trials are needed. This study contributes to the understanding of VF mechanisms and provides a promising treatment option for VF and PMVT. Further research is required to confirm the efficacy of FSM on a tissue level and in larger cohorts.

Keywords

catheter-based fascicular substrate modification

ventricular fibrillation

polymorphic ventricular tachycardia

high-density mapping

Purkinje fibers

ablation endpoint

arrhythmia-free rate

idiopathic VF

abnormal Purkinje potentials

recurrent VF prevention