Evidence map›Paper›PMID 41222769›Full record

ArticleJournal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing2026

Utilizing stored implanted cardiac defibrillator electrograms to target localized fascicular denetworking in catheter ablation of ventricular fibrillation.

Robert N Kerley, Henry Huang, Uyanga Batnyam, Babak Nazer, Esseim Sharma, Jason S Bradfield, Justin H Hayase, Jorge Romero, Chau Vo, Bishnu P Dhakal and 3 more

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Article in Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Robert N KerleyCardiac Arrhythmia Service, Brigham and Women's Hospital, 70 Francis Street, Carl J. and Ruth Shapiro Cardiovascular Center, Boston, MA, 02115, USA. rkerley@bwh.harvard.edu.
Henry HuangDivision of Cardiovascular Medicine, University of Chicago, Chicago, IL, USA.
Uyanga BatnyamDivision of Cardiovascular Medicine, University of Washington, Seattle, WA, USA.
Babak NazerDivision of Cardiovascular Medicine, University of Washington, Seattle, WA, USA.
Esseim SharmaDivision of Cardiovascular Medicine, University Hospitals, Cleveland, OH, USA.
Jason S BradfieldDivision of Cardiovascular Medicine, UCLA, Los Angeles, CA, USA.
Justin H HayaseDivision of Cardiovascular Medicine, UCLA, Los Angeles, CA, USA.
Jorge RomeroUpstate Medical University, Syracuse, NY, USA.
Chau VoDivision of Cardiovascular Medicine, Medical University South Carolina, Charleston, NC, USA.
Bishnu P DhakalDivision of Cardiovascular Medicine, Medical University South Carolina, Charleston, NC, USA.
Jeffrey WinterfieldDivision of Cardiovascular Medicine, Medical University South Carolina, Charleston, NC, USA.
Usha B TedrowCardiac Arrhythmia Service, Brigham and Women's Hospital, 70 Francis Street, Carl J. and Ruth Shapiro Cardiovascular Center, Boston, MA, 02115, USA.
William H SauerCardiac Arrhythmia Service, Brigham and Women's Hospital, 70 Francis Street, Carl J. and Ruth Shapiro Cardiovascular Center, Boston, MA, 02115, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundFascicular substrate modification (FSM) by targeting Purkinje-like potentials (PLPs) with radiofrequency (RF) catheter ablation has been shown to be highly effective in the treatment of ventricular fibrillation (VF). It's unclear if targeting the entire Purkinje network is required to achieve the same result particularly in patients with premature ventricular complex (PVC) triggered VF.

objectiveThis study aimed to examine the utility of the internal cardiac defibrillator (ICD) electrogram (EGM) to target fascicular substrate in the treatment of VF by catheter ablation.

methodsWe analyzed stored EGMs captured in patients presenting with recurrent VF or polymorphic ventricular tachycardia (PMVT). Pacemapping at likely sites for PVC triggers of VF using an analysis of the morphology and relative timing of the stored far- and near-field ICD electrograms of VF triggers was used to identify potential culprit locations. Catheter ablation was performed using high power short duration (HPSD) lesions targeting these specific sites, with a focus on modifying the distal fascicular network.

resultsOf 37 patients in our prospective database, 12 underwent EGM-guided FSM. With a mean follow-up of 12 months, there was a 91.7% freedom from PMVT/VF in patients undergoing EGM-guided FSM using HPSD lesions. There was one instance of left posterior hemiblock but no bundle branch block. There was an increased freedom from ventricular arrhythmia in the EGM-guided group compared to controls, but the difference was not statistically significant (91.7% vs. 76.0%, p = 0.27). There was no significant difference between patients undergoing a targeted Purkinje sparing approach compared to those undergoing substrate modification of the entire left-sided Purkinje network (75.0% vs. 85.5%, p = 0.45).

conclusionStored electrogram-guided ablation allows precise localization and modification of fascicular substrate involved in VF and PMVT. This strategy could potentially enhance the efficiency, effectiveness and safety of Purkinje denetworking by catheter ablation.

Indexed as

Catheter AblationDefibrillators, ImplantableSurgery, Computer-AssistedVentricular FibrillationElectrocardiographyElectrophysiologic Techniques, CardiacFemaleHumansMaleMiddle AgedTreatment OutcomeFascicular substrate modificationHigh power short durationPurkinje denetworkingVentricular fibrillation ablation

Identifiers

PMID41222769

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.