TY - JOUR
T1 - Malignant Purkinje ectopy induced by sodium channel blockers
AU - Escande, William
AU - Gourraud, Jean-Baptiste
AU - Haissaguerre, Michel
AU - Gandjbakhch, Estelle
AU - Lavergne, Thomas
AU - Martins, Raphael
AU - Cheniti, Ghassen
AU - Krisai, Philipp
AU - Hermida, Jean Sylvain
AU - Maury, Philippe
AU - Merino, Jose-Louis
AU - Pasquié, Jean-Luc
AU - Combes, Nicolas
AU - Surget, Elodie
AU - Duchateau, Josselin
AU - Pambrun, Thomas
AU - Derval, Nicolas
AU - Hocini, M. lèze
AU - Jaïs, Pierre
AU - Postema, Pieter G.
AU - Nademanee, Koonlawee
AU - Vigmond, Ed
AU - Bernus, Olivier
AU - Sacher, Frederic
AU - Probst, Vincent
N1 - Funding Information: Funding Sources: This work was supported by the National Research Agency (ANR-10-IAHU04-LIRYC, to Dr Haissaguerre), the European Research Council (FP7/2007-2013 grant agreement number 322886–SYMPHONY, to Dr Haissaguerre) and the Leducq Foundation (RHYTHM network, 16CVD02), the National Research Council of Thailand & Grant in Aid from Bumrungrad Hospital Bangkok, Thailand (to Dr Nademanee), and the Institut du thorax , INSERM , CNRS , UNIV Nantes , France. Publisher Copyright: © 2022 Heart Rhythm Society
PY - 2022/10
Y1 - 2022/10
N2 - Background: Sodium channel blocker (SCB) infusion is used to unmask the electrocardiographic pattern of Brugada syndrome. The test may also induce premature ventricular complexes (PVCs) in individuals without Brugada pattern, the clinical relevance of which is little known. Objective: The purpose of this study was to describe the prevalence of short-coupled (Sc) PVCs induced by ajmaline or flecainide in patients with suspected or documented severe ventricular arrhythmias. Methods: We reviewed the SCB tests performed in 335 patients with suspected ventricular arrhythmias and structurally normal hearts in 9 centers. ScPVCs were defined as frequent and repetitive PVCs with an R-on-T pattern on SCB tests. Repeated SCB tests were performed in 7 patients and electrophysiological mapping of ScPVCs in 9. Results: Sixteen patients (8 men; mean age 36 ± 11 years) showed ScPVCs and were included. ScPVCs appeared 229 ± 118 seconds after the initiation of infusion and displayed coupling intervals of 288 ± 28 ms. ScPVC patterns were monomorphic in 12 patients, originating from the Purkinje system in mapped patients. Repetitive PVCs were induced in 15 patients (94%) including polymorphic ventricular tachycardias in 9 (56%). SCB infusion was repeated 45 (interquartile range 0.6–46) months later and induced identical ScPVC in all. SCB test was the only mean to reveal the malignant arrhythmia in 6 patients. Catheter ablation was performed in 9 patients, resulting in arrhythmia elimination in 8 with a follow-up of 6 (interquartile range 2–9) years. Conclusion: SCB can induce ScPVC, mostly from Purkinje tissue, in a small subset of patients with idiopathic ventricular arrhythmias. Its high reproducibility suggests a distinct individual mechanism.
AB - Background: Sodium channel blocker (SCB) infusion is used to unmask the electrocardiographic pattern of Brugada syndrome. The test may also induce premature ventricular complexes (PVCs) in individuals without Brugada pattern, the clinical relevance of which is little known. Objective: The purpose of this study was to describe the prevalence of short-coupled (Sc) PVCs induced by ajmaline or flecainide in patients with suspected or documented severe ventricular arrhythmias. Methods: We reviewed the SCB tests performed in 335 patients with suspected ventricular arrhythmias and structurally normal hearts in 9 centers. ScPVCs were defined as frequent and repetitive PVCs with an R-on-T pattern on SCB tests. Repeated SCB tests were performed in 7 patients and electrophysiological mapping of ScPVCs in 9. Results: Sixteen patients (8 men; mean age 36 ± 11 years) showed ScPVCs and were included. ScPVCs appeared 229 ± 118 seconds after the initiation of infusion and displayed coupling intervals of 288 ± 28 ms. ScPVC patterns were monomorphic in 12 patients, originating from the Purkinje system in mapped patients. Repetitive PVCs were induced in 15 patients (94%) including polymorphic ventricular tachycardias in 9 (56%). SCB infusion was repeated 45 (interquartile range 0.6–46) months later and induced identical ScPVC in all. SCB test was the only mean to reveal the malignant arrhythmia in 6 patients. Catheter ablation was performed in 9 patients, resulting in arrhythmia elimination in 8 with a follow-up of 6 (interquartile range 2–9) years. Conclusion: SCB can induce ScPVC, mostly from Purkinje tissue, in a small subset of patients with idiopathic ventricular arrhythmias. Its high reproducibility suggests a distinct individual mechanism.
KW - Ajmaline
KW - Flecainide
KW - Idiopathic ventricular fibrillation
KW - Premature ventricular complex
KW - Purkinje system
UR - http://www.scopus.com/inward/record.url?scp=85136744658&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.hrthm.2022.06.034
DO - https://doi.org/10.1016/j.hrthm.2022.06.034
M3 - Article
C2 - 35835363
SN - 1547-5271
VL - 19
SP - 1595
EP - 1603
JO - Heart Rhythm
JF - Heart Rhythm
IS - 10
ER -