Role of Purkinje fibers in post-infarction ventricular tachycardia

OBJECTIVES The objective of this study was to assess the role of Purkinje fibers in monomorphic, post-infarction ventricular tachycardia (VT). BACKGROUND Ventricular fibrillation and polymorphic VT in the setting of acute myocardial infarction (MI) may be triggered by ectopy arising from Purkinje fibers. METHODS From among a group of 81 consecutive patients with post-infarction monomorphic VT referred for catheter ablation, 9 patients were identified in whom the clinical VT had a QRS duration <= 145 ms. Mapping was performed focusing on areas with Purkinje potentials. RESULTS A total of 11 VTs with a QRS duration <= 145 ms were induced and mapped in the 9 patients; 9 of the 11 VTs had a right bundle branch block/left-axis morphology that mimicked left posterior fascicular VT. The mean VT cycle length was 402 +/- 82 ms. Eight of 9 patients had a history of inferior MI involving the left ventricular septum. One patient had an anterior wall MI with septal involvement. Mapping during VT demonstrated re-entry involving the inferior left ventricular wall. In each of the VTs, a Purkinje potential was present at the exit site of the VT re-entry circuit. Single radiofrequency catheter ablation lesions were successful in eliminating these VTs in all patients. CONCLUSIONS The Purkinje system may be part of the re-entry circuit in patients with post-infarction monomorphic VT, resulting in a type of VT with a relatively narrow QRS complex that mimics fascicular VT.