The Initial Part of Polymorphic Ventricular Tachycardia as a Clue for the Sustainability of Tachycardia and Ablation Success: A Varying Degree of Purkinje–Myocardial Complicity?
Journal of Innovations in Cardiac Rhythm Management, vol.14, no.6, pp.5472-5480, 2023 (Scopus)
- Publication Type: Article / Article
- Volume: 14 Issue: 6
- Publication Date: 2023
- Doi Number: 10.19102/icrm.2023.14066
- Journal Name: Journal of Innovations in Cardiac Rhythm Management
- Journal Indexes: Scopus
- Page Numbers: pp.5472-5480
- Keywords: Multiple exits, myocardial substrate, pleomorphic ventricular tachycardia, polymorphic ventricular tachycardia, Purkinje
- Open Archive Collection: AVESIS Open Access Collection
- Akdeniz University Affiliated: Yes
Abstract
The cardiac Purkinje system is capable of very rapid burst activity suggestive of its potential role in being a driver of polymorphic ventricular tachycardia (VT) (PMVT) or ventricular fibrillation (VF). It plays a pivotal role, however, not only in the triggering of but also the perpetuation of ventricular arrhythmias. A varying degree of Purkinje–myocardial complicity has been blamed in determining not only the sustained or non-sustained nature of PMVT but also the pleomorphism of the non-sustained runs. The initial part of PMVT before cascading to the whole ventricle to establish disorganized VF can give important clues for ablation of PMVT and VF. We present a case of an electrical storm after acute myocardial infarction that was successfully ablated after identifying Purkinje potentials that triggered polymorphic, monomorphic, and pleiomorphic VTs and VF.