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Idiopathic ventricular fibrillation triggered by premature ventricular complexes originating from the false tendon of the left ventricle
Journal article   Open access   Peer reviewed

Idiopathic ventricular fibrillation triggered by premature ventricular complexes originating from the false tendon of the left ventricle

Zeba Hashmath and Aditi Naniwadekar
HeartRhythm case reports, Vol.8(7), pp.515-519
07/01/2022
DOI: 10.1016/j.hrcr.2022.05.006
PMID: 35860782
url
https://doi.org/10.1016/j.hrcr.2022.05.006View
Published (Version of record) Open Access

Abstract

Key Teaching Points • Left ventricular false tendons (LVFTs) are endocavitary structures in the ventricle that comprise fibrous tissue, myocardial fibers, blood vessels, and Purkinje fibers. Premature ventricular complexes (PVCs) originating from LVFTs may be due to the increased automaticity of Purkinje cells within muscle fibers or increased excitability owing to mechanical traction at the false tendon attachment site. • PVC triggering ventricular fibrillation (VF) storm is a true electrophysiological emergency and prompts careful evaluation. Treatment of PVC-triggered VF in patients without structural heart disease should first be aimed at studying and promptly removing any reversible proarrhythmic cause, like myocardial ischemia, electrolyte imbalances, QT-prolonging drugs, and inflammation. • Radiofrequency ablation with an intracardiac echocardiography–guided electroanatomical approach should be considered in patients with PVCs originating from LVFTs to improve the efficacy and safety by direct visualization of these dynamic endocavitary structures. • An implantable cardioverter-defibrillator is recommended for secondary prevention of sudden cardiac death in patients with idiopathic ventricular tachycardia/VF in the absence of reversible causes.
 Idiopathic VF Intracardiac echocardiography Left ventricular false tendon Radiofrequency ablation Short-coupled PVCs

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