Cryoablation for Ventricular Arrhythmias Arising From the Papillary Muscles of the Left Ventricle Guided by Intracardiac Echocardiography and Image Integration

JACC. Clinical Electrophysiology
Santiago RiveraFernando Scazzuso

Abstract

This case series reports outcomes and complications of catheter cryoablation at the papillary muscles (PM) of the left ventricle (LV). Catheter radiofrequency ablation is an effective treatment for ventricular arrhythmias (VAs) arising from the PM of the LV. The use of cryoablation at PMs has not been described. Ten patients (70% men; median age: 38 years [range: 34 to 45 years]) with drug-refractory premature ventricular contractions or ventricular tachycardia underwent catheter cryoablation. VAs were localized using 3-dimensional (3D) mapping, multidetector computed tomography, and intracardiac echocardiography, with arrhythmia foci being mapped at either the anterolateral PM or posteromedial papillary muscle (PMPM) of the LV. Focal ablation, up to 240 s with freeze-thaw-freeze cycles was performed using an 8-mm cryoablation catheter via a transmitral approach. Termination of ventricular arrhythmia was observed in all 10 patients during ablation. Median follow-up was 6 months after ablation. The PMPM had higher prevalence of clinical arrhythmias (100% PMPM VAs vs. 10% anterolateral PM VAs). The PM base was the most frequent site of origin of the arrhythmias (60% of patients). Pace-mapping showed ≥11/12 match in all treated PM...Continue Reading

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Citations

Aug 15, 2018·Journal of Cardiovascular Electrophysiology·Jeffrey P GordonGregory E Supple
Apr 16, 2021·Progress in Cardiovascular Diseases·Jose F HuizarKenneth A Ellenbogen
Nov 2, 2021·Clinical Research in Cardiology : Official Journal of the German Cardiac Society·Vanessa SciaccaChristian-H Heeger

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