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?

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Burunkaya D. K., Ozeke O., Korkmaz A., Ozcan F., Kara M., Ozcan Cetin E. H., ...More

Journal of Innovations in Cardiac Rhythm Management, vol.14, no.6, pp.5472-5480, 2023 (Scopus) identifier identifier

  • 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
  • Istanbul Medipol 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.