Frontiers in Cardiovascular Medicine (Sep 2018)

Mapping and Ablation of Idiopathic Ventricular Fibrillation

  • Ghassen Cheniti,
  • Ghassen Cheniti,
  • Ghassen Cheniti,
  • Konstantinos Vlachos,
  • Konstantinos Vlachos,
  • Marianna Meo,
  • Stephane Puyo,
  • Stephane Puyo,
  • Nathaniel Thompson,
  • Nathaniel Thompson,
  • Arnaud Denis,
  • Arnaud Denis,
  • Josselin Duchateau,
  • Josselin Duchateau,
  • Masateru Takigawa,
  • Masateru Takigawa,
  • Claire Martin,
  • Claire Martin,
  • Claire Martin,
  • Antonio Frontera,
  • Antonio Frontera,
  • Takeshi Kitamura,
  • Takeshi Kitamura,
  • Anna Lam,
  • Anna Lam,
  • Felix Bourier,
  • Felix Bourier,
  • Nicolas Klotz,
  • Nicolas Klotz,
  • Nicolas Derval,
  • Nicolas Derval,
  • Frederic Sacher,
  • Frederic Sacher,
  • Pierre Jais,
  • Pierre Jais,
  • Remi Dubois,
  • Meleze Hocini,
  • Meleze Hocini,
  • Michel Haissaguerre,
  • Michel Haissaguerre

DOI
https://doi.org/10.3389/fcvm.2018.00123
Journal volume & issue
Vol. 5

Abstract

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Idiopathic ventricular fibrillation (IVF) is the main cause of unexplained sudden cardiac death, particularly in young patients under the age of 35. IVF is a diagnosis of exclusion in patients who have survived a VF episode without any identifiable structural or metabolic causes despite extensive diagnostic testing. Genetic testing allows identification of a likely causative mutation in up to 27% of unexplained sudden deaths in children and young adults. In the majority of cases, VF is triggered by PVCs that originate from the Purkinje network. Ablation of VF triggers in this setting is associated with high rates of acute success and long-term freedom from VF recurrence. Recent studies demonstrate that a significant subset of IVF defined by negative comprehensive investigations, demonstrate in fact subclinical structural alterations. These localized myocardial alterations are identified by high density electrogram mapping, are of small size and are mainly located in the epicardium. As reentrant VF drivers are often colocated with regions of abnormal electrograms, this localized substrate can be shown to be mechanistically linked with VF. Such areas may represent an important target for ablation.

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