Distinct Purkinje Electrogram Phenotypes at Ventricular Fibrillation Trigger Sites in Idiopathic and Structural Heart Disease.
N, K.R., A, H.H., Uyanga, B., Babak, N., Esseim, S., Elisabeth, W., Mohamed, G., S, B.J., H, H.J., Chau, V., P, D.B., Jeffrey, W., B, T.U., & H, S.W. (2026). Distinct Purkinje Electrogram Phenotypes at Ventricular Fibrillation Trigger Sites in Idiopathic and Structural Heart Disease.. Heart Rhythm. https://doi.org/10.1016/j.hrthm.2026.04.037
N KR, A HH, Uyanga B, Babak N, Esseim S, Elisabeth W, et al. Distinct Purkinje Electrogram Phenotypes at Ventricular Fibrillation Trigger Sites in Idiopathic and Structural Heart Disease.. Heart Rhythm. 2026; doi: 10.1016/j.hrthm.2026.04.037
N KR, A HH, Uyanga B, et al. Distinct Purkinje Electrogram Phenotypes at Ventricular Fibrillation Trigger Sites in Idiopathic and Structural Heart Disease.[J]. Heart Rhythm. 2026. DOI: 10.1016/j.hrthm.2026.04.037.
@article{n2026,
author = {Kerley Robert N and Huang Henry A and Batnyam Uyanga and Nazer Babak and Sharma Esseim and Wong Elisabeth and Gabr Mohamed and Bradfield Jason S and Hayase Justin H and Vo Chau and Dhakal Bishnu P and Winterfield Jeffrey and Tedrow Usha B and Sauer William H},
title = {Distinct Purkinje Electrogram Phenotypes at Ventricular Fibrillation Trigger Sites in Idiopathic and Structural Heart Disease.},
journal = {Heart Rhythm},
year = {2026},
doi = {10.1016/j.hrthm.2026.04.037},
note = {PMID: 42055102},
}
TY - JOUR AU - Kerley Robert N AU - Huang Henry A AU - Batnyam Uyanga AU - Nazer Babak AU - Sharma Esseim AU - Wong Elisabeth AU - Gabr Mohamed AU - Bradfield Jason S AU - Hayase Justin H AU - Vo Chau AU - Dhakal Bishnu P AU - Winterfield Jeffrey AU - Tedrow Usha B AU - Sauer William H TI - Distinct Purkinje Electrogram Phenotypes at Ventricular Fibrillation Trigger Sites in Idiopathic and Structural Heart Disease. T2 - Heart Rhythm PY - 2026 DO - 10.1016/j.hrthm.2026.04.037 AN - PMID:42055102 ER -
Purkinje fibers are established triggers of ventricular fibrillation (VF). In structural heart disease, septal fibrosis and border-zone remodeling may alter Purkinje electrograms at VF-triggering sites; however, classical electrogram criteria derived from structurally normal hearts have not been validated in scarred substrate. To compare Purkinje electrogram morphology at VF-triggering sites in patients with idiopathic versus structural heart disease undergoing catheter ablation. Thirty-seven consecutive patients underwent Purkinje-targeted VF ablation (12 idiopathic, 25 structural). Bipolar electrograms at mapped triggering sites were quantitatively analyzed in 12 patients with discrete trigger localization and high-quality recordings (4 idiopathic, 8 structural). Abnormal Purkinje electrograms were defined as prolonged (>25 ms), multicomponent, or fragmented signals. Abnormal Purkinje-like electrograms were identified almost exclusively in structural patients (7/8 [87.5%] vs. 0/4 idiopathic; p=0.01). Structural VF demonstrated greater electrogram complexity, with more multiphasic components (3.0±1.1 vs. 1.0±0.0; p<0.001), longer Purkinje potential duration (37.9±8.3 vs. 18.0±4.0 ms; p<0.001), and longer Purkinje-ventricular intervals (50.9±13.6 vs. 18.0±4.0 ms; p<0.001). In two structural patients without voltage-defined scar, CT identified septal substrate, with P-V intervals of 28 and 35 ms-intermediate between idiopathic and scar-positive patients. Twelve-month VF-free survival was similar between groups (83.3% vs. 80.0%; p=0.79). Purkinje electrogram morphology at VF-triggering sites differs between idiopathic and structural heart disease and is consistent with differences at the Purkinje-myocardial interface. These findings suggest that electrogram phenotype may inform selection of focal versus substrate-based ablation strategies, supporting a tailored approach that balances arrhythmia control with conduction system preservation.