Purkinje and septal substrate modification as a therapeutic option for patients with STEMI and refractory ventricular fibrillation.

BACKGROUND

Ventricular fibrillation (VF) remains a fatal complication after successful percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI). Radiofrequency catheter ablation (RFCA) targeting the Purkinje network and septal substrate shows promise, but clinical data remain limited.

OBJECTIVE

This study aimed to evaluate the acute and long-term outcomes of RFCA targeting the Purkinje network and septal substrate in patients with STEMI with therapy-refractory VF after successful PCI.

METHODS

Prospective, multicenter cohort of 13 consecutive patients with STEMI with drug-refractory VF storm despite successful PCI. VF occurred a median of 8 days after STEMI [interquartile range 6-13.5]. All underwent urgent RFCA with high-density left ventricular mapping and Purkinje-targeted septal substrate modification, aiming to eliminate spontaneous VF and achieve acute noninducibility during programmed stimulation.

RESULTS

The left anterior descending artery was the predominant culprit vessel, identified in 12 of 13 cases (92.3%). Acute procedural success was achieved in all patients (100%). VF recurrence occurred in 1 of 13 (7.7%) during a median 21-month follow-up [interquartile range 14.5-47] and was successfully treated with repeat ablation. Procedure-related complete atrioventricular block occurred in 2 of 13 (15.4%). In-hospital mortality was 2 of 13 (15.4%), owing to stroke and sepsis.

CONCLUSION

Septal substrate modification targeting the Purkinje network in STEMI patients with therapy-refractory VF-particularly after left anterior descending artery STEMI-may represent an effective therapeutic strategy for arrhythmia control and improved long-term survival. Further studies are needed to confirm these findings.