[Catheter ablation of the distal arborization of the left ventricular Purkinje network in the therapy of recurrent ventricular fibrillation].

An increasing number of studies suggest the role of the Purkinje network and Purkinje-myocardial junction in the development of malignant ventricular arrhythmias. Radiofrequency catheter ablation of the distal arborization of the left ventricular Purkinje network may influence the recurrence of ventricular fibrillation. In three patients (all male, age: 52 ± 6.6 years), radiofrequency ablation of the distal left ventricular Purkinje network was performed due to recurrent ventricular fibrillation despite amiodarone treatment. One patient had hypertrophic cardiomyopathy, another had ischemic cardiomyopathy, and the third had idiopathic ventricular fibrillation. Target identification was achieved by mapping Purkinje-originated ventricular extrasystoles induced by isoproterenol infusion (in two patients) and by pace-mapping based on clinical ECG documentation and intracardiac defibrillator recordings (two patients). The radiofrequency ablation target included the area identified by Purkinje potentials along the left ventricular posterior fascicle and, in one case, also the distal arborization of the anterior fascicle. During a mean follow-up period of 17 ± 11 months following the procedure, one patient experienced malignant ventricular arrhythmia, less frequently than before. In recurrent ventricular fibrillation of various origins, catheter ablation of the distal arborization of the left ventricular Purkinje network may reduce the recurrence of malignant ventricular arrhythmias. Orv Hetil. 2025; 166(8): 307–312.