Catheter Ablation for Triggered Ventricular Fibrillation and Polymorphic Ventricular Tachycardia

Implantable Cardioverter Defibrillator (ICD) remains the first line therapy for patients with primary VF or polymorphic VT. However, catheter ablation of Ventricular Fibrillation (VF) is an important therapeutic option in patients with recurrent VF. These procedures mainly focus on targeting triggers. The role of Ventricular Premature Beat (VPB) initiating VF is crucial and their elimination shown to be effective to prevent recurrence in 82 % after 5 years in idiopathic VF. These VPBs, mainly (87 %) originate from the Purkinje network (right and/or left) and have some specific features. In addition, several experimental studies demonstrated that Purkinje fibers act as initiator and perpetuator of VF. Hence, by ablating an area where the triggering VPB are found to originate, catheter ablation may modify the local substrate too.