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ISSN 2078-7170 (Electronic)

2020, Number 1

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CorSalud 2020; 12 (1)

Role of the Purkinje system and right ventricular outflow tract in malignant ventricular arrhythmias and sudden death

Dorantes SM, Castro HJA, Castañeda CO

Language: Spanish
References: 22
Page: 77-84
PDF size: 573.66 Kb.


ABSTRACT

The Purkinje system and the right ventricular outflow tract play a pivotal role in relation to malignant ventricular arrhythmias (ventricular tachycardia and fibrillation, torsades de pointes) and sudden cardiac death. Details such as their pathophysiology, origin involvement (triggering extrasystoles) maintenance of such arrhythmias, and ablative possibilities to reduce recurrences and electrical storm events are discussed herein. The differential diagnosis between benign and malignant ventricular tachycardia related to the right ventricular outflow tract, and the relationship between genetic, structural, electroanatomical and functional factors (inflammation, fibrosis) with clinical events and vulnerability to arrhythmias are presented. Some of these diseases need to be reclassified as they are now seen in their organic-functional character (Brugada syndrome, for example), and this implies radical changes in some classical concepts as well as a new perspective on risk stratification and therapeutic management.


REFERENCES

  1. Ideker RE, Kong W, Pogwizd S. Purkinje fibers and arrhythmias. Pacing Clin Electrophysiol. 2009; 32(3):283-5.

  2. Scheinman MM. Role of the His-Purkinje system in the genesis of cardiac arrhythmia. Heart Rhythm. 2009;6(7):1050-8.

  3. Rosenheck S. Arrhythmogenicity of the Purkinje system: a new step toward understanding ventricular fibrillation. Heart Rhythm. 2009;6(12): 1790-1.

  4. Laurent G, Saal S, Amarouch MY, Béziau DM, Marsman RF, Faivre L, et al. Multifocal ectopic Purkinje-related premature contractions: a new SCN5A-related cardiac channelopathy. J Am Coll Cardiol. 2012;60(2):144-56.

  5. Backx PH. Serving up the ping-pong mechanisms for biventricular ventricular tachycardia. Heart Rhythm. 2011;8(4):606-7.

  6. Baher AA, Uy M, Xie F, Garfinkel A, Qu Z, Weiss JN. Bidirectional ventricular tachycardia: ping pong in the His-Purkinje system. Heart Rhythm. 2011;8(4):599-605.

  7. Anderson RD, Kumar S, Kalman JM, Sanders P, Sacher F, Hocini M, et al. Catheter ablation of ventricular fibrillation. Heart Lung Circ. 2019;28(1): 110-22.

  8. Tan VH, Yap J, Hsu LF, Liew R. Catheter ablation of ventricular fibrillation triggers and electrical storm. Europace. 2012;14(12):1687-95.

  9. Lindsay BD. Eliminating triggers of ventricular fibrillation: the past, present, and future. J Am Coll Cardiol. 2009;54(6):529-30.

  10. Haïssaguerre M, Shoda M, Jaïs P, Nogami A, Shah DC, Kautzner J, et al. Mapping and ablation of idiopathic ventricular fibrillation. Circulation. 2002; 106(8):962-7.

  11. Capulzini L, Brugada P, Brugada J, Brugada R. Arritmias y enfermedades del corazón derecho: de las bases genéticas a la clínica. Rev Esp Cardiol. 2010;63(8):963-83.

  12. Noda T, Shimizu W, Taguchi A, Aiba T, Satomi K, Suyama K, et al. Malignant entity of idiopathic ventricular fibrillation and polymorphic ventricular tachycardia initiated by premature extrasystoles originating from the right ventricular outflow tract. J Am Coll Cardiol. 2005;46(7):1288-94.

  13. Boukens BJ, Coronel R, Christoffels VM. Embryonic development of the right ventricular outflow tract and arrhythmias. Heart Rhythm. 2016;13(2): 616-22.

  14. Viskin S, Antzelevitch C. The cardiologists' worst nightmare sudden death from “benign” ventricular arrhythmias. J Am Coll Cardiol. 2005;46(7): 1295-7.

  15. Shimizu W. Arrhythmias originating from the right ventricular outflow tract: how to distinguish “malignant” from “benign”? Heart Rhythm. 2009;6(10): 1507-11.

  16. Viskin S, Rosso R, Rogowski O, Belhassen B. The “short-coupled” variant of right ventricular outflow ventricular tachycardia: a not-so-benign form of benign ventricular tachycardia? J Cardiovasc Electrophysiol. 2005;16(8):912-6.

  17. Dorantes M, Ponce EF. Extrasístoles ventriculares con intervalo corto de acoplamiento: su trascendencia. CorSalud [Internet]. 2015 [citado 31 Ago 2019];7(4):253-7. Disponible en: http://www.revcorsalud.sld.cu/index.php/cors/ar ticle/view/72/143

  18. Dorantes M, Ponce E, Falcón R. Extrasístoles ventriculares con intervalo corto de acoplamiento como detonantes de arritmias malignas. CorSalud [Internet]. 2016 [citado 31 Ago 2019];8:144-152. Disponible en: http://www.revcorsalud.sld.cu/index.php/cors/ar ticle/view/134/319

  19. Pieroni M, Notarstefano P, Oliva A, Campuzano O, Santangeli P, Coll M, et al. Electroanatomic and pathologic right ventricular outflow tract abnormalities in patients with Brugada Syndrome. J Am Coll Cardiol. 2018;72(22):2747-57.

  20. Brugada J, Pappone C, Berruezo A, Vicedomini G, Manguso F, Ciconte G, et al. Brugada Syndrome phenotype elimination by epicardial substrate ablation. Circ Arrhythm Electrophysiol. 2015;8(6): 1373-81.

  21. Corrado D, Migliore F, Zorzi A. Brugada Syndrome: In search of a cause. J Am Coll Cardiol. 2018;72(22):2758-60.

  22. Martini B, Martini N, Dorantes Sánchez M, Márquez MF, Zhang L, Fontaine G, et al. Pistas de una enfermedad orgánica subyacente en el síndrome de Brugada. Arch Cardiol Mex. 2017;87(1):49-60.




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