Adjunctive Purkinje Denetworking During Ventricular Tachycardia Ablation in Patients with Prior Ventricular Fibrillation-Article: Adjunctive Purkinje Denetworking During Ventricular Tachycardia Ablation in Patients with Prior Ventricular Fibrillation

Article: Adjunctive Purkinje Denetworking During Ventricular Tachycardia Ablation in Patients with Prior Ventricular Fibrillation

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This multicenter retrospective study examined whether adding Purkinje denetworking (PDN) to standard ventricular tachycardia (VT) ablation improves outcomes in patients who had previously experienced spontaneous polymorphic VT (PMVT) or ventricular fibrillation (VF). Fifty-five patients were included: 27 received VT ablation plus adjunctive PDN, and 28 underwent VT ablation alone.<br /><br />At 12 months, the PDN group had better VT/VF-free survival than the ablation-only group (80.8% vs 49.2%). PDN was associated with a significantly lower risk of recurrent VT/VF overall (hazard ratio [HR] 0.29) and an even lower risk of recurrent PMVT/VF specifically (HR 0.20). The advantage remained similar in a propensity-adjusted analysis. Both groups had marked reductions in implantable cardioverter-defibrillator (ICD) therapies after ablation.<br /><br />Procedurally, PDN did not significantly increase procedure time or overall complication rates, but it was associated with more frequent iatrogenic left bundle branch block (14.8% vs 3.6%). No patients required permanent pacing or device upgrade, and serious complications were rare.<br /><br />The authors conclude that in this high-risk population with prior VF, adding PDN during VT ablation may reduce recurrent arrhythmias and ICD shocks, likely by addressing residual Purkinje-mediated triggers and conduction pathways that standard scar-based VT ablation may miss. However, because the study was retrospective, nonrandomized, and relatively small, the findings need prospective confirmation.

Meta Tag

Concept Purkinje System

Concept Ventricular Tachycardia

Concept Ventricular Fibrillation

Concept Transient Polymorphic Ventricular Tachycardia

Concept Purkinje Denetworking

Keywords

Purkinje denetworking

ventricular tachycardia ablation

polymorphic ventricular tachycardia

ventricular fibrillation

ICD shocks

arrhythmia recurrence

retrospective multicenter study

left bundle branch block

catheter ablation

VT/VF-free survival

Purkinje System

Ventricular Tachycardia

Ventricular Fibrillation

Transient Polymorphic Ventricular Tachycardia

Purkinje Denetworking