Why Ablation of Sites With Purkinje Activation Is Antiarrhythmic: The Interplay Between Fast Activation and Arrhythmogenesis

• Published in: Frontiers in physiology Vol. 12; p. 648396
• Main Authors: Coronel, Ruben, Potse, Mark, Haïssaguerre, Michel, Derval, Nicolas, Rivaud, Mathilde R, Meijborg, Veronique M F, Cluitmans, Matthijs, Hocini, Mélèze, Boukens, Bastiaan J
• Format: Journal Article
• Language: English
• Published: Switzerland Frontiers 23-03-2021; Frontiers Media S.A
• Subjects: ablation; arrhythmias; Cardiology and cardiovascular system; early repolarization syndrome; electrophysiology; Human health and pathology; idiopathic ventricular fibrillation; Life Sciences; Physiology; Purkinje; idiopathic ventricular fibrillation; early repolarization syndrome; Purkinje; arrhythmias; electrophysiology; ablation; Idiopathic ventricular fibrillation; Electrophysiology; Ablation; Arrhythmias; Early repolarization syndrome
• ISSN: 1664-042X; 1664-042X
• DOI: 10.3389/fphys.2021.648396

Ablation of sites showing Purkinje activity is antiarrhythmic in some patients with idiopathic ventricular fibrillation (iVF). The mechanism for the therapeutic success of ablation is not fully understood. We propose that deeper penetrance of the Purkinje network allows faster activation of the ventricles and is proarrhythmic in the presence of steep repolarization gradients. Reduction of Purkinje penetrance, or its indirect reducing effect on apparent propagation velocity may be a therapeutic target in patients with iVF.