Idiopathic Ventricular Fibrillation: Substrates, Mechanisms and Treatment

Idiopathic VF is a complex clinical entity that is characterised by an evolving scope over time. Arrhythmogenic cardiomyopathy and electrical diseases represent a significant proportion of diagnoses attributed during follow-up in patients with an initial diagnosis of idiopathic VF. Stepwise diagnostic workup and management are of paramount importance. We proposed that idiopathic VF can be split into two distinct phenotypes, with potential overlap in an individual patient. In patients with Purkinje-related idiopathic VF, short-coupled ventricular ectopy can be documented, and ablation of the culprit tissue is a reasonable strategy to avoid recurrence. In patients with microstructural idiopathic VF, localised myocardial alterations can be unveiled by thorough electro-anatomical mapping and are amenable to a substrate-elimination strategy. Idiopathic VF is also a dynamic and evolving field, with promising research, new diagnostic tools and ablation techniques being developed in the near future.