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Ventricular premature depolarizations (VPDs) frequently occur de novo after a myocardial infarction (MI) and have been associated with arrhythmogenic sudden cardiac death. The understanding of the mechanisms underlying the initiation of the VPDs and its relationship to ventricular fibrillation (VF) in these patients is deficient. The Purkinje network has been implicated in the initiation of monomorphic VPDs that can trigger VF in patients with no structural heart disease. In addition, in the setting of ischemic cardiomyopathy, VPDs from the border zone of the scar have been shown to be a potential trigger for VF. Interestingly, Purkinje potentials are commonly recorded at the site of origin of the triggering VPDs. We present a case of a patient with postinfarction monomorphic VPDs exiting from different sites of the Purkinje network and initiating VF.

A case of ventricular fibrillation triggered by ventricular premature depolarizations exiting from different sites of the Purkinje network