Ventricular arrhythmias involving the His-Purkinje system in the structurally abnormal heart

Pacing Clin Electrophysiol. 2018 Sep;41(9):1051-1059. doi: 10.1111/pace.13465. Epub 2018 Aug 27.

Abstract

His-Purkinje-related ventricular arrhythmias are a subset of ventricular tachycardias that use the specialized cardiac conduction system. These arrhythmias can occur in various different forms of structural heart disease. Here, we review the basic science discoveries and their analogous clinical observations that implicate the His-Purkinje system as a crucial component of the arrhythmia circuit. While mutations serve the molecular basis for arrhythmias in the heritable cardiomyopathies, transcriptional and posttranslational changes constitute the adverse remodeling leading to arrhythmias in acquired structural heart disease. Additional studies on the electrical properties of the His-Purkinje network and its interactions with the surrounding myocardium will improve the clinical diagnosis and treatment of these arrhythmias.

Keywords: VT; ablation; animal studies; electrophysiology-basic; electrophysiology-clinical.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Bundle of His / physiopathology*
  • Electrocardiography
  • Electrophysiologic Techniques, Cardiac
  • Humans
  • Purkinje Fibers / physiopathology*
  • Tachycardia, Ventricular / diagnosis
  • Tachycardia, Ventricular / genetics
  • Tachycardia, Ventricular / physiopathology*
  • Ventricular Remodeling / physiology