TY - JOUR
T1 - Localized Structural Alterations Underlying a Subset of Unexplained Sudden Cardiac Death
AU - Haïssaguerre, Michel
AU - Hocini, Mélèze
AU - Cheniti, Ghassen
AU - Duchateau, Josselin
AU - Sacher, Frédéric
AU - Puyo, Stéphane
AU - Cochet, Hubert
AU - Takigawa, Masateru
AU - Denis, Arnaud
AU - Martin, Ruairidh
AU - Derval, Nicolas
AU - Bordachar, Pierre
AU - Ritter, Philippe
AU - Ploux, Sylvain
AU - Pambrun, Thomas
AU - Klotz, Nicolas
AU - Massoullié, Gregoire
AU - Pillois, Xavier
AU - Dallet, Corentin
AU - Schott, Jean Jacques
AU - Scouarnec, Solena
AU - Ackerman, Michael J.
AU - Tester, David
AU - Piot, Olivier
AU - Pasquié, Jean Luc
AU - Leclerc, Christophe
AU - Hermida, Jean Sylvain
AU - Gandjbakhch, Estelle
AU - Maury, Philippe
AU - Labrousse, Louis
AU - Coronel, Ruben
AU - Jais, Pierre
AU - Benoist, David
AU - Vigmond, Edward
AU - Potse, Mark
AU - Walton, Richard
AU - Nademanee, Koonlawee
AU - Bernus, Olivier
AU - Dubois, Remi
N1 - Funding Information:
This study was supported by the National Research Agency (ANR-10-IAHU04-LIRYC), the European Research Council (FP7/2007–2013 grant agreement number 322886, SYMPHONY), and the Leducq Foundation (RHYTHM network).
Publisher Copyright:
© 2018 American Heart Association, Inc.
PY - 2018/7/1
Y1 - 2018/7/1
N2 - Background: Sudden cardiac death because of ventricular fibrillation (VF) is commonly unexplained in younger victims. Detailed electrophysiological mapping in such patients has not been reported. Methods: We evaluated 24 patients (29±13 years) who survived idiopathic VF. First, we used multielectrode body surface recordings to identify the drivers maintaining VF. Then, we analyzed electrograms in the driver regions using endocardial and epicardial catheter mapping during sinus rhythm. Established electrogram criteria were used to identify the presence of structural alterations. Results: VF occurred spontaneously in 3 patients and was induced in 16, whereas VF was noninducible in 5. VF mapping demonstrated reentrant and focal activities (87% versus 13%, respectively) in all. The activities were dominant in one ventricle in 9 patients, whereas they had biventricular distribution in others. During sinus rhythm areas of abnormal electrograms were identified in 15/24 patients (62.5%) revealing localized structural alterations: in the right ventricle in 11, the left ventricle in 1, and both in 3. They covered a limited surface (13±6 cm 2 ) representing 5±3% of the total surface and were recorded predominantly on the epicardium. Seventy-six percent of these areas were colocated with VF drivers (P<0.001). In the 9 patients without structural alteration, we observed a high incidence of Purkinje triggers (7/9 versus 4/15, P=0.033). Catheter ablation resulted in arrhythmia-free outcome in 15/18 patients at 17±11 months follow-up. Conclusions: This study shows that localized structural alterations underlie a significant subset of previously unexplained sudden cardiac death. In the other subset, Purkinje electrical pathology seems as a dominant mechanism.
AB - Background: Sudden cardiac death because of ventricular fibrillation (VF) is commonly unexplained in younger victims. Detailed electrophysiological mapping in such patients has not been reported. Methods: We evaluated 24 patients (29±13 years) who survived idiopathic VF. First, we used multielectrode body surface recordings to identify the drivers maintaining VF. Then, we analyzed electrograms in the driver regions using endocardial and epicardial catheter mapping during sinus rhythm. Established electrogram criteria were used to identify the presence of structural alterations. Results: VF occurred spontaneously in 3 patients and was induced in 16, whereas VF was noninducible in 5. VF mapping demonstrated reentrant and focal activities (87% versus 13%, respectively) in all. The activities were dominant in one ventricle in 9 patients, whereas they had biventricular distribution in others. During sinus rhythm areas of abnormal electrograms were identified in 15/24 patients (62.5%) revealing localized structural alterations: in the right ventricle in 11, the left ventricle in 1, and both in 3. They covered a limited surface (13±6 cm 2 ) representing 5±3% of the total surface and were recorded predominantly on the epicardium. Seventy-six percent of these areas were colocated with VF drivers (P<0.001). In the 9 patients without structural alteration, we observed a high incidence of Purkinje triggers (7/9 versus 4/15, P=0.033). Catheter ablation resulted in arrhythmia-free outcome in 15/18 patients at 17±11 months follow-up. Conclusions: This study shows that localized structural alterations underlie a significant subset of previously unexplained sudden cardiac death. In the other subset, Purkinje electrical pathology seems as a dominant mechanism.
KW - catheter ablation
KW - endocardium
KW - epicardial mapping
KW - incidence
KW - sudden cardiac death
KW - ventricular fibrillation
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U2 - 10.1161/CIRCEP.117.006120
DO - 10.1161/CIRCEP.117.006120
M3 - Article
C2 - 30002064
AN - SCOPUS:85054544355
SN - 1941-3149
VL - 11
JO - Circulation: Arrhythmia and Electrophysiology
JF - Circulation: Arrhythmia and Electrophysiology
IS - 7
M1 - e006120
ER -