41. Advances in Mapping of Ventricular Fibrillation and Defibrillation: Role of the Purkinje System

  1. Mohammad Shenasa MD4,
  2. Gerhard Hindricks MD5,
  3. Martin Borggrefe MD6,
  4. Günter Breithardt MD7 and
  5. Mark E. Josephson MD8
  1. Derek J. Dosdall1,
  2. Paul B. Tabereaux2 and
  3. Raymond E. Ideker3

Published Online: 18 DEC 2012

DOI: 10.1002/9781118481585.ch41

Cardiac Mapping, Fourth Edition

Cardiac Mapping, Fourth Edition

How to Cite

Dosdall, D. J., Tabereaux, P. B. and Ideker, R. E. (2013) Advances in Mapping of Ventricular Fibrillation and Defibrillation: Role of the Purkinje System, in Cardiac Mapping, Fourth Edition (eds M. Shenasa, G. Hindricks, M. Borggrefe, G. Breithardt and M. E. Josephson), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781118481585.ch41

Editor Information

  1. 4

    Attending Physician, Department of Cardiovascular Services, O'Connor Hospital, Heart & Rhythm Medical Group, San Jose, California, USA

  2. 5

    Professor of Medicine (Cardiology), University Leipzig, Heart Center, Director, Department of Electrophysiology, Leipzig, Germany

  3. 6

    Professor of Medicine (Cardiology), Head, Department of Cardiology, Angiology and Pneumology, University Medical Center, Mannheim Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany

  4. 7

    Professor Emeritus of Medicine and Cardiology, Department of Cardiology and Angiology, Hospital of the University of Münster, Münster, Germany

  5. 8

    Chief, Cardiovascular Medicine Division, Director, Harvard-Thorndike Electrophysiology Institute and Arrhythmia Service, Beth Israel Deaconess Medical Center, Herman C. Dana Professor of Medicine, Harvard Medical School, Boston, Massachusetts, USA

Author Information

  1. 1

    CARMA Center, Division of Cardiology, University of Utah School of Medicine, Salt Lake City, UT, USA

  2. 2

    Heart Center, Inc. Huntsville, AL, USA

  3. 3

    Departments of Cardiovascular Disease, Physiology and Bioengineering, University of Alabama at Birmingham, Birmingham, AL, USA

Publication History

  1. Published Online: 18 DEC 2012
  2. Published Print: 10 JAN 2013

ISBN Information

Print ISBN: 9780470670460

Online ISBN: 9781118481585

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Keywords:

  • Purkinje system;
  • ventricular tachycardia;
  • ventricular fibrillation;
  • triggered activity;
  • specialized conduction system

Summary

The Purkinje system plays a critical role in spreading activation from the atrioventricular node to the working myocardium throughout the ventricles in normal sinus rhythm. Recent mapping studies have shown that the Purkinje system may be a source of rapid activation in ventricular tachyarrhythmias (VTs) and ventricular fibrillation (VF). Clinical ablation procedures targeting activity in the Purkinje system have successfully treated a subset of VT/VF patients. Animal mapping studies have demonstrated that the Purkinje system may drive the rapid activation rate of VF, particularly after 2-3 minutes of VF. While activation patterns in early VF are consistent with intramural re-entry, in prolonged VF the Purkinje system continues to activate rapidly and drive the activation rate.