Mechanistic insights into initiation and maintenance of ventricular fibrillation: implications for catheter ablation

Abstract

Objective: This report is intended to provide an overview of the mechanism(s) of ventricular fibrillation (VF) and its relation to catheter ablation.

Methods and result: We conducted a Pubmed and Medline literature search to identify all experimental and clinical studies published in English involving the mechanisms of VF and catheter ablation for VF. We found that controversies still exist with respect to the initiation and maintenance of VF despite more than a century of research due to the complexity of this arrhythmia and the limitation of the mapping technology. However, catheter ablation targeting the triggering factor for VF has been successfully applied in some patients who experience failure of drug therapy and frequent implanted cardiac defibrillator shocks.

Conclusions: VF is frequently triggered by short-coupled monophasic ventricular premature beats. VF is characteristic of partial and temporal organization instead of a state of completely aperiodic and disordered activation. Catheter ablation targeting the triggers for VF seems to be a safe and effective means for preventing VF in some patients.