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Currently the characteristics and potential mechanism of idiopathic ventricular fibrillation (IVF) are still not well known. Though implantable cardioverter defibrillator (ICD) is recommended as one first-line treatment for IVF, the prognosis and recurrent rate seem to be unsatisfactory. This article is to investigate the characteristics with IVF patients, and compare the efficacy of radiofrequency (RF) and ICD in recurrence rates.
Case reports were analyzed, which date from seven-ninety cases, including PUBMED (up to March 2017), EMBASE (up to March 2017), China integrated Knowledge Resources Databases (up to March 2017) and WanFang Database (up to March 2017).
We identified 75 case reports, of which 31 cases remain controversial in diagnosis and therefore were excluded. Eventually 44 case reports, including 51 patients were recruited into analysis. Meta-analysis showed that about 58.5% IVF patients were males. The average age of onset was 33y (33.16±13.659), with approximately 60.8% first manifestation of syncope. Only 9.8% patients had family history. In these patients, up to 82.4% were induced by premature ventricular contraction (PVC), 60% with the origin of right ventricle. The coupled intervals (CIs) of the PVCs tended to decrease significantly (1st PVC - 2nd PVC: 52.727±42.109, 95%CI 34.057-71.397, p<0.001; 2nd PVC-3rd PVC: 42.857±29.179, 95%CI 29.575-56.139, p<0.001). Class Ia drugs and verapamil could be effective in VF suppression. Moreover, IVF patients in RF+ICD group (p=0.006) or RF group (p=0.002) had lower recurrence rates than ICD group. Radiofrequency ablation could successfully prevent the recurrence in IVF patients (β=-2.626, Wald=8.462, p=0.004).
In patients with IVF, this meta-analysis suggested that the PVCs with shortened coupled interval might be one potential mechanism in the onset of VF. Radiofrequency ablation could be an effective precaution in VF recurrence.