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PubMed

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Mode and Characteristics of Arrhythmia Initiation in Idiopathic Ventricular Fibrillation: A THESIS Substudy

JACC. Clinical electrophysiology. 2024 Aug ; 10 (8) : 1794-1809. [epub] 20240605

JACC Clin Electrophysiol
ISSN 2405-5018 | 2405-500X
Source

Language English Country United States Media print-electronic

Document type Journal Article, Multicenter Study

Persistent link https://www.medvik.cz/link/pmid38842971

PubMed 38842971
DOI 10.1016/j.jacep.2024.03.036
PII: S2405-500X(24)00276-7
Knihovny.cz E-resources

Keywords
idiopathic ventricular fibrillation, long-coupled ventricular arrhythmias, pause-dependency, polymorphic ventricular tachycardia, short-coupled ventricular arrhythmias,
MeSH
Adult MeSH
Electrocardiography MeSH
Ventricular Fibrillation * epidemiology MeSH
Catheter Ablation MeSH
Tachycardia, Ventricular physiopathology MeSH
Middle Aged MeSH
Humans MeSH
Young Adult MeSH
Check Tag
Adult MeSH
Middle Aged MeSH
Humans MeSH
Young Adult MeSH
Male MeSH
Female MeSH
Publication type
Journal Article MeSH
Multicenter Study MeSH

BACKGROUND: There is limited information on the mode of arrhythmia initiation in idiopathic ventricular fibrillation (IVF). A non-pause-dependent mechanism has been suggested to be the rule. OBJECTIVES: The aim of this study was to assess the mode and characteristics of initiation of polymorphic ventricular tachycardia (PVT) in patients with short or long-coupled PVT/IVF included in THESIS (THerapy Efficacy in Short or long-coupled idiopathic ventricular fibrillation: an International Survey), a multicenter study involving 287 IVF patients treated with drugs or radiofrequency ablation. METHODS: We reviewed the initiation of 410 episodes of ≥1 PVT triplet in 180 patients (58.3% females; age 39.6 ± 13.6 years) with IVF. The incidence of pause-dependency arrhythmia initiation (prolongation by >20 ms of the preceding cycle length) was assessed. RESULTS: Most arrhythmias (n = 295; 72%) occurred during baseline supraventricular rhythm without ambient premature ventricular complexes (PVCs), whereas 106 (25.9%) occurred during baseline rhythm including PVCs. Nine (2.2%) arrhythmias occurred during atrial/ventricular pacing and were excluded from further analysis. Mode of PVT initiation was pause-dependent in 45 (15.6%) and 64 (60.4%) of instances in the first and second settings, respectively, for a total of 109 of 401 (27.2%). More than one type of pause-dependent and/or non-pause-dependent initiation (mean: 2.6) occurred in 94.4% of patients with ≥4 events. Coupling intervals of initiating PVCs were <350 ms, 350-500 ms, and >500 ms in 76.6%, 20.72%, and 2.7% of arrhythmia initiations, respectively. CONCLUSIONS: Pause-dependent initiation occurred in more than a quarter of arrhythmic episodes in IVF patients. PVCs having long (between 350 and 500 ms) and very long (>500 ms) coupling intervals were observed at the initiation of nearly a quarter of PVT episodes.

Arrhythmia and Electrophysiology Department IRCCS Policlinico San Donato Milan Italy

Arrhythmia Institute Cardiovascular Division Shamir Medical Center Be'er Ya'akov Israel and Tel Aviv University Tel Aviv Israel

Cardiac Electrophysiology St Bartholomew's Hospital London United Kingdom

Cardiocenter 2nd Internal Clinic Cardiology and Angiology General Faculty Hospital Charles University Prague Czech Republic

Cardiology Department Hospital Universitario Virgen de las Nieves Granada Spain

Cardiology Division Department of Medicine Brigham and Women's Hospital Boston Massachusetts USA

Cardiovascular Genetics Centre Montreal Heart Institute and Faculty of Medicine Université de Montreal Montreal Quebec Canada

Center for Cardiovascular Innovation Division of Cardiology University of British Columbia Vancouver British Columbia Canada

Clinic 2 for Internal Medicine University Hospital Salzburg Paracelsus Medical University Salzburg Salzburg Austria

Department of Advanced Arrhythmia and Translational Medical Science National Cerebral and Cardiovascular Center Suita Japan

Department of Cardiology 2 University Hospital Münster Münster Germany

Department of Cardiology CHRU Nancy Université de Lorraine Nancy France