Background:Parents of children with complex right ventricular outflow tract(RVOT)anomalies are confronted with their child’s need for heart surgery early in life and repeated reoperations later on.Preoperative assess...Background:Parents of children with complex right ventricular outflow tract(RVOT)anomalies are confronted with their child’s need for heart surgery early in life and repeated reoperations later on.Preoperative assessment needs to be performed whenever an indication for reoperation is suspected.The aim was to illuminate the experiences of parents of children diagnosed with RVOT anomalies,in particular,how they experience their child’s heart disease and everyday life during the assessment and after the decision on whether to perform a reoperation.Method:Individual interviews(n=27)were conducted with nine parents on three occasions between 2014 and 2016 and analyzed using reflexive thematic analysis.Results:The analysis resulted in the following five main coexisting themes:The heart surgery keeps my child alive illuminates parents’experiences during and after the assessment and emphasizes that heart surgery,although dreaded,is central for their child’s survival;Everyday struggles illuminates the different struggles parents had to face to ensure that their child would be in the best possible condition;the remaining three themes,Unconditional love,Trust in life,and Togetherness,illuminate the ways in which the parents gained inner strength and confidence in their everyday lives.Conclusion:Although the parents were grateful for the assessment and had learned to navigate among the fears it aroused,they experienced several distressing situations during the assessment process that should be addressed.By inviting both the parents and their child to participate in the child’s care,individualized support can take into account the needs of both parents and child.展开更多
Summary: Lead placement for ventricular pacing variably impacts the physiological benefit of the pa- tient. This study evaluated the ventricular lead performance and safety of right ventricular outflow tract septal p...Summary: Lead placement for ventricular pacing variably impacts the physiological benefit of the pa- tient. This study evaluated the ventricular lead performance and safety of right ventricular outflow tract septal pacing in patients with bradyarrhythmia in South China over 60-month follow-up. Totally, 192 patients (108 males, and 84 females, 63-4-21 years old) with bradyarrhythmia were randomly divided into two groups. The right ventricular outflow tract septum (RVOTs) group had lead placement near the sep- tum (n=97), while the right ventricular apex (RVA) group had a traditional apical placement (n=95). RV septal lead positioning was achieved with a specialized stylet and confirmed using fluoroscopic projec- tion. All patients were followed up for 60 months. Follow-up assessment included stimulation threshold, R-wave sensing, lead impedance and lead complications. The time of electrode implantation in both the ROVTs and RVA groups were significantly different (4.29±0.61 vs. 2.16±0.22 min; P=0.009). No dif- ferences were identified in threshold, impedance or R-wave sensing between the two groups at 1 st, 12th, 36th and 60th month during the follow-up period. No occurrence of electrode displacement, increased pacing threshold or inadequate sensing was found. The long-term active fixation ventricular electrode performance in RVOTs group was similar to that in RVA group. RVOTs pacing near the septum using active fixation electrodes may provide stability during long-term follow-up period.展开更多
Current permanent right ventricular and right atrial endocardial pacing leads are implanted utilizing a central lumen stylet. Right ventricular apex pacing initiates an abnormal asynchronous electrical activation patt...Current permanent right ventricular and right atrial endocardial pacing leads are implanted utilizing a central lumen stylet. Right ventricular apex pacing initiates an abnormal asynchronous electrical activation pattern, which results in asynchronous ventricular contraction and relaxation. When pacing from right atrial appendage, the conduction time between two atria will be prolonged, which results in heterogeneity for both depolarization and repolarization. Six patients with Class Ⅰ indication for permanent pacing were implanted with either single chamber or dual chamber pacemaker. The SelectSecure 3830 4-French (Fr) lumenless lead and the SelectSite C304 8.5-Fr steerable catheter-sheath (Medtronic Inc., USA) were used. Pre-selected pacing sites included inter-atrial septum and right ventricular outflow tract, which were defined by ECG and fluoroscopic criteria. All the implanting procedures were successful without complication. Testing results (mean atrial pacing threshold: 0.87 V; mean P wave amplitude: 2.28 mV; mean ventricular pacing threshold: 0.53V; mean R wave amplitude: 8.75 mV) were satisfactory. It is concluded that implantation of a 4-Fr lumenless pacing lead by using a streerable catheter-sheath to achieve inter-atrial septum or right ventricular outflow tract pacing is safe and feasible.展开更多
A 63-year-old patient presented with dyspnea and chest distress. A computerized tomography and echocardiogram showed a cardiac mass in the right ventricle, which caused obstruction of the right ventricular outflow tra...A 63-year-old patient presented with dyspnea and chest distress. A computerized tomography and echocardiogram showed a cardiac mass in the right ventricle, which caused obstruction of the right ventricular outflow tract. Coronary angiography revealed a dense meshwork of the abnomorly capillary vessels originating from right coronary artery. The mass was completely excised under cardiopulmonary bypass. The mass attached right ventricle lateral wall and posterior triscupid leaflet. Histology was typical myomatous tissue.展开更多
Objective Right ventricular outflow tract septum has become widely used us an electrode placement site. However, data concerning lead performances and complications for lead repositioning with this technique were scan...Objective Right ventricular outflow tract septum has become widely used us an electrode placement site. However, data concerning lead performances and complications for lead repositioning with this technique were scant. The purpose of this study was to observe long- term lead performances and complications of right ventricular outflow tract septal pacing and provide evidences for choosing an optimal electrode implantation site. Methods Thirty-six patients with septal active electrode implantation and 39 with apical passive electrode implantation were enrolled in this study. Pacing threshold, R-wave sensing, lead impedance, pacing QRS width and pacing-related compli- cations for two groups at implantation and follow-up were compared. Results There were higher pacing threshold and shorter pacing QRS width at implantation in the septal group compared with the apical group. There were no differences between the septal and the apical groups in pacing threshold, R-wave sensitivity, lead impedance and pace-related complication during a follow-up. Conclusions Right ventricular outflow tract septum could be used as a first choice for implantation site because it had long-term stable lead performances and no serious complications compared with the traditional apical site.展开更多
Objective To compare the short-term clinical effect and electrical parameters of His-purkinje bundle pacing(HPBP) and right ventricular inflow tract septal pacing(RVIP) in the elderly. Methods Between April 2017 and S...Objective To compare the short-term clinical effect and electrical parameters of His-purkinje bundle pacing(HPBP) and right ventricular inflow tract septal pacing(RVIP) in the elderly. Methods Between April 2017 and September 2019, sixty patients with indications for permanent cardiac pacing and resynchronization therapy in Beijing Anzhen Hospital were divided into the HPBP and RVIP groups, and were analyzed. A ventricular pacing lead was implanted in left ventricular septal sites with left bundle potentials or His potentials in the HPBP group. The lead was placed in right ventricular inflow tract septal sites close to distal His-bundle regions without potentials from the His-purkinje conduction system in the RVIP group. Lead impedance, R wave amplitude, pacing thresholds, QRS duration, left ventricular ejection fraction(LVEF), and left ventricular end-diastolic diameter(LVEDD), mitral regurgitation area reflux, QTc, T wave directivity, Tp-e and Tp-e/QT ratio were compared between the HPBP and RVIP groups during the procedure and the short-month follow-up. Results No significant differences were found in lead impedance, R wave amplitude, QRS duration, LVEF, LVEDD, mitral regurgitation area reflux, QTc, T wave directivity, Tp-e and Tp-e/QT ratio between the HPBP and RVIP groups. However, the pacing threshold was significantly lower in the HPBP group than in the RVIP group(0.7 ± 0.2 vs. 0.9 ± 0.3 V, P = 0.02). Conclusions The efficacy and electrical parameters of HPBP is comparable with RVIP during the procedure and the short-term follow-up.展开更多
Objective: For patients of TOF with pulmonary annular hypoplasia, reconstruction of right ventricular outflow tract (RVOT) often requires a trans annular patch (TAP). The present study aims to compare the outcomes of ...Objective: For patients of TOF with pulmonary annular hypoplasia, reconstruction of right ventricular outflow tract (RVOT) often requires a trans annular patch (TAP). The present study aims to compare the outcomes of TOF repair using Polytetrafluoroethylene (PTFE) patch versus autologous glutaraldehyde fixed pericardial patch for RVOT reconstruction. Materials and methods: 103 consecutive patients undergoing TOF repair in whom TAP was required were randomized into two groups: Group I (pericardial patch), Group II (PTFE patch). Postoperative outcomes in terms of postoperative heart rhythm, duration of mechanical ventilation, mediastinal and pleural drainage, length of stay in intensive care unit (ICU) and hospital mortality were assessed. A separate team of cardiologists independently evaluated pre- and post-operative gradients across the RVOT, degree of pulmonary insufficiency, right ventricular systolic function. Results: There were no significant differences between the two groups in terms of the incidence of postoperative arrhythmias, duration of mechanical ventilation, length of intensive care unit or hospital stay. The requirement of inotropes was no different in the PTFE patch group as compared with the pericardial patch group (16.84 ± 7.04 vs. 17.90 ± 6.71, median 19 vs. 20, p = 0.825). The re-exploration rate was higher in the PTFE group as compared with the pericardial patch group (6 vs. 1). Postoperative Echocar-diography revealed no differences in the RV systolic function between the two groups before discharge. Conclusion: In patients undergoing TOF repair, using a PTFE patch yields comparable results. However, the efficacy of PTFE will only be established once;mid-term and long-term results are available.展开更多
Background:Mechanisms and clinical manifestations of coronary artery complications after right ventricular outflow tract reconstruction surgery are not well known.Methods:Patients who had coronary artery complications...Background:Mechanisms and clinical manifestations of coronary artery complications after right ventricular outflow tract reconstruction surgery are not well known.Methods:Patients who had coronary artery complications after pulmonary valve replacement or the Rastelli procedure at a single tertiary centre were retrospectively analysed.Results:Coronary artery complications were identified in 20 patients who underwent right ventricular outflow tract reconstruction surgery.The median age at diagnosis of coronary artery complication was 21 years(interquartile range:13–25 years).Mechanisms of coronary artery complications were compression by adjacent materials in 12 patients,dynamic compression of intramural course of coronary artery in two patients,and intraoperative injury in six patients.Congenital coronary artery anomalies were identified in 50%(10/20)of patients.Four patients presented with early postoperative haemodynamic instability.Fourteen patients showed late onset symptoms or signs of coronary insufficiency,including chest pain,ventricular dysfunction,or ventricular arrhythmias.Coronary artery stenosis was incidentally found on cardiac computed tomography angiography in two asymptomatic patients.Four patients underwent surgical interventions,and one patient underwent percutaneous coronary intervention for coronary stenosis.One patient with recurrent ventricular tachycardia required an implantable cardioverter-defibrillator.There were two deaths in patients with intraoperative coronary injury.Conclusion:Preoperative coronary evaluation and long-term follow-up for the development of coronary artery complications are required in patients undergoing right ventricular outflow tract reconstruction surgery to prevent ventricular dysfunction,arrhythmias,and death,especially among those with congenital coronary anomalies.展开更多
Objective:To observe the HRV changes before and after the radiofrequency current catheter ablationventricular premature beats originated from different site of right ventricular outflow tract.Methods:A total of 102 pa...Objective:To observe the HRV changes before and after the radiofrequency current catheter ablationventricular premature beats originated from different site of right ventricular outflow tract.Methods:A total of 102 patients with frequent RVOT-VPC admitted to our hospital were accepted radiofrequency current catheter ablation (RF). According to the origin of RVOT-VPC, it was divided into 2 groups, one is from ventricular septum, and the other one is from free wall, and in each group, male and female are observed separately.Results:(1) HRV before RF ablation: 1) rMSSD in the female patients with RVOT-VPC from free wall was significantly lower than those from septum;2) frequency domain index (W, LF) were higher than normal range, and in male patients, LF/HF<1 were found, but in female patients, LF/HF>1. (2) HRV after RF ablation: 1) Significant changes were found in female patients with RVOT-VPC from septum, rMSSD, PNN50, HF and LF decreased;2) In female patients with RVOT-VPC from free wall, rMSSD decreased;3) In male patients, there were no significant HRV changes found before and after RF ablation. (3) Heart rate changes: 1) In female patients with RVOT-VPC from septum, heart rate decreased significantly ((76.47±9.47) bpm vs (69.29±14.59) bpm)2) No significant changes were found in male patients.Conclusion:In patients with RVOT-PVC sympathetic and vagus excitability increased, and after catheter ablation, in female patients with RVOT-PVC originated from septum, the HRV index relating to sympathetic and vagus excitability significantly decreased.展开更多
Ventricular fibrillation (VF) is a malignant arrhythmia, usually initiated by a ventricular premature contraction (VPC) during the vulnerable period of cardiac repolarization. Ablation therapy for VF has been desc...Ventricular fibrillation (VF) is a malignant arrhythmia, usually initiated by a ventricular premature contraction (VPC) during the vulnerable period of cardiac repolarization. Ablation therapy for VF has been described and increasingly reported. Targets for VF triggers are VPCs preceded by Purkinje potentials or from the right ventricular outflow tract (RVOT) in structurally normal hearts, and VPC triggers preceded by Purkinje potentials in ischemic cardiomyopathy. During the session, mapping should be focused on the earliest activation and determining the earliest potential is the key to a successful ablation. However, suppression of VF can be achieved by not only the elimination of triggering VPCs, but also by substrate modification of possible reentry circuits in the Purkinje network, or between the PA and RVOT. The most important issue before the ablation session is the recording of the 12-lead ECG of the triggering event, which can prove invaluable in regionalizing the origin of the triggering VPC for more detailed mapping. In cases where the VPC is not spontaneous or inducible, ablation may be performed by pace mapping. Further studies are needed to evaluate the precise mechanisms of this arrhythmia.展开更多
基金This study was supported by the Pediatric Heart Center at Skåne University Hospital Lund and Lund University,and by the Swedish Children’s Heart Association.
文摘Background:Parents of children with complex right ventricular outflow tract(RVOT)anomalies are confronted with their child’s need for heart surgery early in life and repeated reoperations later on.Preoperative assessment needs to be performed whenever an indication for reoperation is suspected.The aim was to illuminate the experiences of parents of children diagnosed with RVOT anomalies,in particular,how they experience their child’s heart disease and everyday life during the assessment and after the decision on whether to perform a reoperation.Method:Individual interviews(n=27)were conducted with nine parents on three occasions between 2014 and 2016 and analyzed using reflexive thematic analysis.Results:The analysis resulted in the following five main coexisting themes:The heart surgery keeps my child alive illuminates parents’experiences during and after the assessment and emphasizes that heart surgery,although dreaded,is central for their child’s survival;Everyday struggles illuminates the different struggles parents had to face to ensure that their child would be in the best possible condition;the remaining three themes,Unconditional love,Trust in life,and Togetherness,illuminate the ways in which the parents gained inner strength and confidence in their everyday lives.Conclusion:Although the parents were grateful for the assessment and had learned to navigate among the fears it aroused,they experienced several distressing situations during the assessment process that should be addressed.By inviting both the parents and their child to participate in the child’s care,individualized support can take into account the needs of both parents and child.
基金supported in part by grants from the Science and Technology Key Foundation of Guangdong Province(No.2010B031600166)the Science and Technology Foundation of Guangdong Province(No.2011B061300072)
文摘Summary: Lead placement for ventricular pacing variably impacts the physiological benefit of the pa- tient. This study evaluated the ventricular lead performance and safety of right ventricular outflow tract septal pacing in patients with bradyarrhythmia in South China over 60-month follow-up. Totally, 192 patients (108 males, and 84 females, 63-4-21 years old) with bradyarrhythmia were randomly divided into two groups. The right ventricular outflow tract septum (RVOTs) group had lead placement near the sep- tum (n=97), while the right ventricular apex (RVA) group had a traditional apical placement (n=95). RV septal lead positioning was achieved with a specialized stylet and confirmed using fluoroscopic projec- tion. All patients were followed up for 60 months. Follow-up assessment included stimulation threshold, R-wave sensing, lead impedance and lead complications. The time of electrode implantation in both the ROVTs and RVA groups were significantly different (4.29±0.61 vs. 2.16±0.22 min; P=0.009). No dif- ferences were identified in threshold, impedance or R-wave sensing between the two groups at 1 st, 12th, 36th and 60th month during the follow-up period. No occurrence of electrode displacement, increased pacing threshold or inadequate sensing was found. The long-term active fixation ventricular electrode performance in RVOTs group was similar to that in RVA group. RVOTs pacing near the septum using active fixation electrodes may provide stability during long-term follow-up period.
基金supported by a grant form a Program of Science and Technology Development of Hubei Province (2004AA304B09).
文摘Current permanent right ventricular and right atrial endocardial pacing leads are implanted utilizing a central lumen stylet. Right ventricular apex pacing initiates an abnormal asynchronous electrical activation pattern, which results in asynchronous ventricular contraction and relaxation. When pacing from right atrial appendage, the conduction time between two atria will be prolonged, which results in heterogeneity for both depolarization and repolarization. Six patients with Class Ⅰ indication for permanent pacing were implanted with either single chamber or dual chamber pacemaker. The SelectSecure 3830 4-French (Fr) lumenless lead and the SelectSite C304 8.5-Fr steerable catheter-sheath (Medtronic Inc., USA) were used. Pre-selected pacing sites included inter-atrial septum and right ventricular outflow tract, which were defined by ECG and fluoroscopic criteria. All the implanting procedures were successful without complication. Testing results (mean atrial pacing threshold: 0.87 V; mean P wave amplitude: 2.28 mV; mean ventricular pacing threshold: 0.53V; mean R wave amplitude: 8.75 mV) were satisfactory. It is concluded that implantation of a 4-Fr lumenless pacing lead by using a streerable catheter-sheath to achieve inter-atrial septum or right ventricular outflow tract pacing is safe and feasible.
文摘A 63-year-old patient presented with dyspnea and chest distress. A computerized tomography and echocardiogram showed a cardiac mass in the right ventricle, which caused obstruction of the right ventricular outflow tract. Coronary angiography revealed a dense meshwork of the abnomorly capillary vessels originating from right coronary artery. The mass was completely excised under cardiopulmonary bypass. The mass attached right ventricle lateral wall and posterior triscupid leaflet. Histology was typical myomatous tissue.
文摘Objective Right ventricular outflow tract septum has become widely used us an electrode placement site. However, data concerning lead performances and complications for lead repositioning with this technique were scant. The purpose of this study was to observe long- term lead performances and complications of right ventricular outflow tract septal pacing and provide evidences for choosing an optimal electrode implantation site. Methods Thirty-six patients with septal active electrode implantation and 39 with apical passive electrode implantation were enrolled in this study. Pacing threshold, R-wave sensing, lead impedance, pacing QRS width and pacing-related compli- cations for two groups at implantation and follow-up were compared. Results There were higher pacing threshold and shorter pacing QRS width at implantation in the septal group compared with the apical group. There were no differences between the septal and the apical groups in pacing threshold, R-wave sensitivity, lead impedance and pace-related complication during a follow-up. Conclusions Right ventricular outflow tract septum could be used as a first choice for implantation site because it had long-term stable lead performances and no serious complications compared with the traditional apical site.
文摘Objective To compare the short-term clinical effect and electrical parameters of His-purkinje bundle pacing(HPBP) and right ventricular inflow tract septal pacing(RVIP) in the elderly. Methods Between April 2017 and September 2019, sixty patients with indications for permanent cardiac pacing and resynchronization therapy in Beijing Anzhen Hospital were divided into the HPBP and RVIP groups, and were analyzed. A ventricular pacing lead was implanted in left ventricular septal sites with left bundle potentials or His potentials in the HPBP group. The lead was placed in right ventricular inflow tract septal sites close to distal His-bundle regions without potentials from the His-purkinje conduction system in the RVIP group. Lead impedance, R wave amplitude, pacing thresholds, QRS duration, left ventricular ejection fraction(LVEF), and left ventricular end-diastolic diameter(LVEDD), mitral regurgitation area reflux, QTc, T wave directivity, Tp-e and Tp-e/QT ratio were compared between the HPBP and RVIP groups during the procedure and the short-month follow-up. Results No significant differences were found in lead impedance, R wave amplitude, QRS duration, LVEF, LVEDD, mitral regurgitation area reflux, QTc, T wave directivity, Tp-e and Tp-e/QT ratio between the HPBP and RVIP groups. However, the pacing threshold was significantly lower in the HPBP group than in the RVIP group(0.7 ± 0.2 vs. 0.9 ± 0.3 V, P = 0.02). Conclusions The efficacy and electrical parameters of HPBP is comparable with RVIP during the procedure and the short-term follow-up.
文摘Objective: For patients of TOF with pulmonary annular hypoplasia, reconstruction of right ventricular outflow tract (RVOT) often requires a trans annular patch (TAP). The present study aims to compare the outcomes of TOF repair using Polytetrafluoroethylene (PTFE) patch versus autologous glutaraldehyde fixed pericardial patch for RVOT reconstruction. Materials and methods: 103 consecutive patients undergoing TOF repair in whom TAP was required were randomized into two groups: Group I (pericardial patch), Group II (PTFE patch). Postoperative outcomes in terms of postoperative heart rhythm, duration of mechanical ventilation, mediastinal and pleural drainage, length of stay in intensive care unit (ICU) and hospital mortality were assessed. A separate team of cardiologists independently evaluated pre- and post-operative gradients across the RVOT, degree of pulmonary insufficiency, right ventricular systolic function. Results: There were no significant differences between the two groups in terms of the incidence of postoperative arrhythmias, duration of mechanical ventilation, length of intensive care unit or hospital stay. The requirement of inotropes was no different in the PTFE patch group as compared with the pericardial patch group (16.84 ± 7.04 vs. 17.90 ± 6.71, median 19 vs. 20, p = 0.825). The re-exploration rate was higher in the PTFE group as compared with the pericardial patch group (6 vs. 1). Postoperative Echocar-diography revealed no differences in the RV systolic function between the two groups before discharge. Conclusion: In patients undergoing TOF repair, using a PTFE patch yields comparable results. However, the efficacy of PTFE will only be established once;mid-term and long-term results are available.
文摘Background:Mechanisms and clinical manifestations of coronary artery complications after right ventricular outflow tract reconstruction surgery are not well known.Methods:Patients who had coronary artery complications after pulmonary valve replacement or the Rastelli procedure at a single tertiary centre were retrospectively analysed.Results:Coronary artery complications were identified in 20 patients who underwent right ventricular outflow tract reconstruction surgery.The median age at diagnosis of coronary artery complication was 21 years(interquartile range:13–25 years).Mechanisms of coronary artery complications were compression by adjacent materials in 12 patients,dynamic compression of intramural course of coronary artery in two patients,and intraoperative injury in six patients.Congenital coronary artery anomalies were identified in 50%(10/20)of patients.Four patients presented with early postoperative haemodynamic instability.Fourteen patients showed late onset symptoms or signs of coronary insufficiency,including chest pain,ventricular dysfunction,or ventricular arrhythmias.Coronary artery stenosis was incidentally found on cardiac computed tomography angiography in two asymptomatic patients.Four patients underwent surgical interventions,and one patient underwent percutaneous coronary intervention for coronary stenosis.One patient with recurrent ventricular tachycardia required an implantable cardioverter-defibrillator.There were two deaths in patients with intraoperative coronary injury.Conclusion:Preoperative coronary evaluation and long-term follow-up for the development of coronary artery complications are required in patients undergoing right ventricular outflow tract reconstruction surgery to prevent ventricular dysfunction,arrhythmias,and death,especially among those with congenital coronary anomalies.
基金Natural Science Foundation Project of Beijing(7122173).
文摘Objective:To observe the HRV changes before and after the radiofrequency current catheter ablationventricular premature beats originated from different site of right ventricular outflow tract.Methods:A total of 102 patients with frequent RVOT-VPC admitted to our hospital were accepted radiofrequency current catheter ablation (RF). According to the origin of RVOT-VPC, it was divided into 2 groups, one is from ventricular septum, and the other one is from free wall, and in each group, male and female are observed separately.Results:(1) HRV before RF ablation: 1) rMSSD in the female patients with RVOT-VPC from free wall was significantly lower than those from septum;2) frequency domain index (W, LF) were higher than normal range, and in male patients, LF/HF<1 were found, but in female patients, LF/HF>1. (2) HRV after RF ablation: 1) Significant changes were found in female patients with RVOT-VPC from septum, rMSSD, PNN50, HF and LF decreased;2) In female patients with RVOT-VPC from free wall, rMSSD decreased;3) In male patients, there were no significant HRV changes found before and after RF ablation. (3) Heart rate changes: 1) In female patients with RVOT-VPC from septum, heart rate decreased significantly ((76.47±9.47) bpm vs (69.29±14.59) bpm)2) No significant changes were found in male patients.Conclusion:In patients with RVOT-PVC sympathetic and vagus excitability increased, and after catheter ablation, in female patients with RVOT-PVC originated from septum, the HRV index relating to sympathetic and vagus excitability significantly decreased.
文摘Ventricular fibrillation (VF) is a malignant arrhythmia, usually initiated by a ventricular premature contraction (VPC) during the vulnerable period of cardiac repolarization. Ablation therapy for VF has been described and increasingly reported. Targets for VF triggers are VPCs preceded by Purkinje potentials or from the right ventricular outflow tract (RVOT) in structurally normal hearts, and VPC triggers preceded by Purkinje potentials in ischemic cardiomyopathy. During the session, mapping should be focused on the earliest activation and determining the earliest potential is the key to a successful ablation. However, suppression of VF can be achieved by not only the elimination of triggering VPCs, but also by substrate modification of possible reentry circuits in the Purkinje network, or between the PA and RVOT. The most important issue before the ablation session is the recording of the 12-lead ECG of the triggering event, which can prove invaluable in regionalizing the origin of the triggering VPC for more detailed mapping. In cases where the VPC is not spontaneous or inducible, ablation may be performed by pace mapping. Further studies are needed to evaluate the precise mechanisms of this arrhythmia.