作者
Elodie Surget,Ghassen Cheniti,F. Daniel Ramirez,Antoine Leenhardt,Akihiko Nogami,Estelle Gandjbakhch,Fabrice Extramiana,Françoise Hidden-Lucet,Xavier Pillois,David Benoist,Philipp Krisai,Yosuke Nakatani,Takashi Nakashima,Takamitsu Takagi,Tsukasa Kamakura,Clémentine André,Nicolas Welte,Remi Chauvel,Romain Tixier,Josselin Duchateau,Thomas Pambrun,Nicolas Derval,Pierre Jaïs,Frederic Sacher,Olivier Bernus,Mélèze Hocini,Michel Haïssaguerre
摘要
Background Purkinje ectopics (PurkEs) are major triggers of idiopathic ventricular fibrillation (VF). Identifying clinical factors associated with specific PurkE characteristics could yield insights into the mechanisms of Purkinje-mediated arrhythmogenicity. Objective The purpose of this study was to examine the associations of clinical, environmental, and genetic factors with PurkE origin in patients with PurkE-initiated idiopathic VF. Methods Consecutive patients with PurkE-initiated idiopathic VF from 4 arrhythmia referral centers were included. We evaluated demographic characteristics, medical history, clinical circumstances associated with index VF events, and electrophysiological characteristics of PurkEs. An electrophysiology study was performed in most patients to confirm the Purkinje origin. Results Eighty-three patients were included (mean age 38 ± 14 years; 44 [53%] women), of whom 32 had a history of syncope. Forty-four patients had VF at rest. PurkEs originated from the right ventricle (RV) in 41 patients (49%), from the left ventricle (LV) in 36 (44%), and from both ventricles in 6 (7%). Seasonal and circadian distributions of VF episodes were similar according to PurkE origin. The clinical characteristics of patients with RV vs LV PurkE origins were similar, except for sex. RV PurkEs were more frequent in men than in women (76% vs 24%), whereas LV and biventricular PurkEs were more frequent in women (81% vs 19% and 83% vs 17%, respectively) (P Conclusion PurkEs triggering idiopathic VF originate dominantly from the RV in men and from the LV or both ventricles in women, adding to other sex-related arrhythmias such as Brugada syndrome or long QT syndrome. Sex-based factors influencing Purkinje arrhythmogenicity warrant investigation.