Pleomorphism of Premature Ventricular Complexes originating from Papillary Muscles and their Myocardial Connections.
Journal
Heart rhythm
ISSN: 1556-3871
Titre abrégé: Heart Rhythm
Pays: United States
ID NLM: 101200317
Informations de publication
Date de publication:
16 Oct 2023
16 Oct 2023
Historique:
received:
14
08
2023
revised:
29
09
2023
accepted:
06
10
2023
medline:
19
10
2023
pubmed:
19
10
2023
entrez:
18
10
2023
Statut:
aheadofprint
Résumé
Patients with arrhythmias originating from papillary muscles (PAP) often have pleomorphic ventricular arrhythmias (PVA) that can result in failed ablations. The mechanism of PVAs is unknown. The purpose of this study was to assess the prevalence, mechanisms of PVAs and impact on outcomes in patients with focal left ventricular (LV) PAP VAs. The sites of origin (SOO) of VAs in 43 consecutive patients referred for ablation of focal LV PAP VAs were determined by activation and pace-mapping. SOOs were classified as 1. unifocal generating a single VA morphology, 2. unifocal from a deeper-seated origin generating multiple VA morphologies, 3. unifocal located on a PAP branching site, 4. multifocal from a single or multiple PAPs generating multiple VA morphologies, and 5. multifocal from a PAP and a different anatomic source. Most patients had multiple morphologies (n=34,79%) and multiple mechanisms (79%) generating the different VA morphologies. Most of the patients with PVAs had multiple SOOs from a single or different PAPs (n=23, 68%) followed by patients with SOOs from PAP and non-PAP sites (n=19, 56%). In 13 patients (38%) single SOOs accounted for the observed PVAs. The frequent observation (n=20) of changing QRS morphologies after RF delivery targeting a single VA suggests the presence of a deeper focus with changing sites of preferential conduction. VA pleomorphism in patients with PAP arrhythmias is most often due to PVCs originating from different SOOs. The second most common cause is preferential conduction from a single SOO via PAP branching sites.
Sections du résumé
BACKGROUND
BACKGROUND
Patients with arrhythmias originating from papillary muscles (PAP) often have pleomorphic ventricular arrhythmias (PVA) that can result in failed ablations. The mechanism of PVAs is unknown.
OBJECTIVE
OBJECTIVE
The purpose of this study was to assess the prevalence, mechanisms of PVAs and impact on outcomes in patients with focal left ventricular (LV) PAP VAs.
METHODS
METHODS
The sites of origin (SOO) of VAs in 43 consecutive patients referred for ablation of focal LV PAP VAs were determined by activation and pace-mapping. SOOs were classified as 1. unifocal generating a single VA morphology, 2. unifocal from a deeper-seated origin generating multiple VA morphologies, 3. unifocal located on a PAP branching site, 4. multifocal from a single or multiple PAPs generating multiple VA morphologies, and 5. multifocal from a PAP and a different anatomic source.
RESULTS
RESULTS
Most patients had multiple morphologies (n=34,79%) and multiple mechanisms (79%) generating the different VA morphologies. Most of the patients with PVAs had multiple SOOs from a single or different PAPs (n=23, 68%) followed by patients with SOOs from PAP and non-PAP sites (n=19, 56%). In 13 patients (38%) single SOOs accounted for the observed PVAs. The frequent observation (n=20) of changing QRS morphologies after RF delivery targeting a single VA suggests the presence of a deeper focus with changing sites of preferential conduction.
CONCLUSIONS
CONCLUSIONS
VA pleomorphism in patients with PAP arrhythmias is most often due to PVCs originating from different SOOs. The second most common cause is preferential conduction from a single SOO via PAP branching sites.
Identifiants
pubmed: 37852565
pii: S1547-5271(23)02803-5
doi: 10.1016/j.hrthm.2023.10.012
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2023. Published by Elsevier Inc.