Updated results on catheter ablation of ventricular arrhythmias arising from the papillary muscles of the left ventricle.

BACKGROUND

Catheter ablation of ventricular arrhythmias (VAs) arising from the left ventricle`s (LV) papillary muscles (PM) is challenging. In this study we present results of catheter ablation using multiple energy sources and image-based approaches.

METHODS

Fifty-three patients (49 ± 17 years old; 34% females; median LV ejection fraction 53 ± 11%) underwent catheter cryoablation or radiofrequency (RF) ablation with non-contact force sensing (Non-CFS) catheters and cardiac computed tomography integration (CTII) into the electroanatomical mapping system or contact force sensing RF (CFS RF) ablation catheters and intracardiac echo-facilitated 3D electroanatomical mapping. Ventricular arrhythmias foci were mapped at either the anterolateral (ALPM) or posteromedial papillary muscles (PMPM). Ablation was performed using an 8-mm cryoablation catheter (CRYO); a Non-CFS 4-mm open-irrigated RF catheter; or a CFS RF 3.5-mm open-irrigated tip catheter, via transmitral or transaortic approach.

RESULTS

Acute success rate was 83% for Non-CFS RF/CTII; 100% for CRYO/CTII (n = 16) and CFS RF/ICE3D (n = 14) (

CONCLUSIONS

Non-CFS/CTII was associated with an increased risk of recurrence of the clinical arrhythmia. Ablation with either CFS RF/ICE3D or CRYO/CTII showed high acute success rates and low recurrence rates during follow-up. Cryoablation provided stable contact and was less arrhythmogenic.