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  • Title: Role of Purkinje fibers in post-infarction ventricular tachycardia.
    Author: Bogun F, Good E, Reich S, Elmouchi D, Igic P, Tschopp D, Dey S, Wimmer A, Jongnarangsin K, Oral H, Chugh A, Pelosi F, Morady F.
    Journal: J Am Coll Cardiol; 2006 Dec 19; 48(12):2500-7. PubMed ID: 17174189.
    Abstract:
    OBJECTIVES: The objective of this study was to assess the role of Purkinje fibers in monomorphic, post-infarction ventricular tachycardia (VT). BACKGROUND: Ventricular fibrillation and polymorphic VT in the setting of acute myocardial infarction (MI) may be triggered by ectopy arising from Purkinje fibers. METHODS: From among a group of 81 consecutive patients with post-infarction monomorphic VT referred for catheter ablation, 9 patients were identified in whom the clinical VT had a QRS duration < or =145 ms. Mapping was performed focusing on areas with Purkinje potentials. RESULTS: A total of 11 VTs with a QRS duration < or =145 ms were induced and mapped in the 9 patients; 9 of the 11 VTs had a right bundle branch block/left-axis morphology that mimicked left posterior fascicular VT. The mean VT cycle length was 402 +/- 82 ms. Eight of 9 patients had a history of inferior MI involving the left ventricular septum. One patient had an anterior wall MI with septal involvement. Mapping during VT demonstrated re-entry involving the inferior left ventricular wall. In each of the VTs, a Purkinje potential was present at the exit site of the VT re-entry circuit. Single radiofrequency catheter ablation lesions were successful in eliminating these VTs in all patients. CONCLUSIONS: The Purkinje system may be part of the re-entry circuit in patients with post-infarction monomorphic VT, resulting in a type of VT with a relatively narrow QRS complex that mimics fascicular VT.
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