1
|
Shan R, Gao Y, Wang W, Wang J, Li X, Yuan X, Wang X. Dark papillary muscles sign is a new prognostic indicator in patients with dilated cardiomyopathy: A multi-center study. Int J Cardiol 2024; 417:132583. [PMID: 39306289 DOI: 10.1016/j.ijcard.2024.132583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 09/06/2024] [Accepted: 09/18/2024] [Indexed: 09/27/2024]
Abstract
OBJECTIVES The prognostic value of left ventricular (LV) papillary muscle anomalies in dilated cardiomyopathy (DCM) patients is unclear. The objective of this study was to evaluate the prognostic significance of LV papillary muscle anomalies in DCM patients using cardiac magnetic resonance (CMR). METHODS 369 DCM patients who underwent CMR at two Chinese medical facilities from January 2019 to June 2023 were retrospectively and consecutively included in total. The various features of the LV papillary muscles were taken into consideration: thickness, attachment, supernumerary papillary muscles, angles, and signal intensity. The end-systolic signal hypointensity of both papillary muscles in early post-contrast cine CMR images was identified as Dark-Paps. Major adverse cardiac events (MACEs) were assessed, and all patients were followed up. RESULTS 119 patients (32.2 %) had Dark-Paps and 141 patients (38.2 %) experienced MACE during a median follow-up of 22 months. According to Kaplan-Meier curve analysis, patients who had Dark-Paps had a lower survival rate free from MACE (log-rank, p < 0.001). Dark-Paps maintained an independent predictor of MACE in a multivariate model that included left ventricular ejection fraction (LVEF) and late gadolinium enhancement (LGE) extent (HR: 3.49; p < 0.001). Furthermore, adding Dark-Paps to the multivariate model greatly enhanced the prognostic role of endpoint events (C-statistic improvement: 0.652-0.777, Delong test: p < 0.001). CONCLUSION Dark-Paps is a potent independent indicator of major adverse cardiac events in dilated cardiomyopathy patients. In addition, Dark-Paps can provide additional prognostic value over the multivariable baseline clinical model.
Collapse
Affiliation(s)
- Rongxue Shan
- School of Medicine, Shandong First Medical University, Jinan, Shandong 271099, China; Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
| | - Yan Gao
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China; Department of Radiology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong 250021, China
| | - Wenxian Wang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China; School of Medical Imaging, Binzhou Medical University, No. 346 Guanhai Road, Yantai, Shandong 264003, PR China
| | - Jian Wang
- Department of Radiology, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
| | - Xiaofan Li
- Circle Cardiovascular Imaging Inc, Suite 1100, 800 5th Avenue SW, Calgary, AB T2P 3T6, Canada
| | - Xianshun Yuan
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
| | - Ximing Wang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China; Department of Radiology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong 250021, China.
| |
Collapse
|
2
|
Jiang CX, Li SL, Li MM, Tang RB, Sang CH, Wang W, Dong JZ, Long DY, Zei PC, Ma CS. Transseptal approach versus retrograde aortic approach in mapping and ablation of ventricular arrhythmias from anterolateral papillary muscles. J Cardiovasc Electrophysiol 2024. [PMID: 39075656 DOI: 10.1111/jce.16335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 05/20/2024] [Accepted: 05/26/2024] [Indexed: 07/31/2024]
Abstract
INTRODUCTION The anterior and lateral position of the anterolateral papillary muscle (ALPM) has found to be reached with better catheter stability and less mechanical bumping via the transseptal (TS) compared to the retrograde aortic (RA) approach. The aim of this study is to compare the TS and RA approaches on mapping and ablation of ventricular arrhythmias (VAs) arising from ALPMs. METHODS Thirty-two patients with ALPM-VAs undergoing mapping and ablation via the TS approach were included and compared with 31 patients via the RA approach within the same period. Acute success was compared, as well as other outcomes including misinterpreted mapping results due to bumping, radiofrequency (RF) attempts, procedural time and success rate at 12-month follow-up. RESULTS Acute success was achieved in more cases in the TS group (96.4% vs. 72.0%, p = .020). During activation mapping, bump-provoked premature ventricular complexes (PVCs) misinterpreted as clinical PVCs were more common in the RA group (30.0% vs. 58.3%, p = .036), leading to more RF attempts (3.5 ± 2.7 vs. 7.2 ± 6.8, p = .006). Suppression of VAs were finally achieved in the unsuccessful cases by changing to the alternative approach, but the procedural time was significantly less in the TS group (90.0 ± 33.0 vs. 113.7 ± 41.1 min, p = .027) with less need to change the approach, although follow-up success rates were similar (75.0% vs. 71.0%, p = .718). CONCLUSION A TS rather than RA approach as the initial approach appears to facilitate mapping and ablation of ALPM-VAs, specifically by decreasing the possibility of misleading mapping results caused by bump-provoked PVC, and increase the acute success rate thereby.
Collapse
Affiliation(s)
- Chen-Xi Jiang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Shao-Long Li
- Department of Cardiology, Yan'an Hospital Affiliated to Kunming Medical University, Kunming, China
| | - Meng-Meng Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ri-Bo Tang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Cai-Hua Sang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wei Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jian-Zeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - De-Yong Long
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Paul C Zei
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Chang-Sheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
3
|
Chen T, Chang L, Rong B, Zhang K, Fan G, Kong J, Ling M, Kong Q, Maduray K, Zhao C, Zhong J. Combination of Intracardiac Echocardiography and Contact Force Sensing for Left Ventricular Papillary Muscle Arrhythmias. J Clin Med 2023; 12:jcm12093154. [PMID: 37176594 PMCID: PMC10179325 DOI: 10.3390/jcm12093154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/04/2023] [Accepted: 04/23/2023] [Indexed: 05/15/2023] Open
Abstract
OBJECTIVES The catheter ablation of ventricular arrhythmias (VAs) arising from the left ventricular (LV) papillary muscles (PMs) is challenging. This study sought to address whether the combination of intracardiac echocardiography (ICE) and contact force sensing (CFS) can improve the acute and long-term ablation outcomes of left ventricular papillary muscle arrhythmias. METHODS AND RESULTS From May 2015 to August 2022, a total of thirty-three patients underwent catheter ablation for LV PM arrhythmias: VAs were located in anterolateral PMs in 11 and posteromedial PMs in 22. A combination of intracardiac echocardiography (ICE) and contact force sensing (CFS) was used in 21 of the 33 procedures. A mean of 6.93 ± 4.91 for lesions was used per patient, comparable between the CFS/ICE and no ICE/CFS (4.90 ± 2.23 vs. 10.17 ± 5.89; p = 0.011). The mean CF achieved in the ICE/CFS group was 7.52 ± 3.31 g. Less X-ray time was used in the combination group (CFS/ICE: 165.67 ± 47.80 S vs. no ICE/CFS: 365.00 ± 183.73 S; p < 0.001). An acute success rate of 100% was achieved for the ICE/CFS group (n = 22) and 66.67% for the no ICE/CFS group (n = 8). VA recurrence at the 11.21 ± 7.21-month follow-up was 14.2% for the ICE/CFS group and 50% for the no ICE/CFS group (p = 0.04). No severe complications occurred in all patients. CONCLUSIONS The combination of intracardiac echocardiography (ICE) and contact force sensing (CFS) could provide precise geometries of cardiac endocavitary structures and accurate contact information for the catheter during ablation, which improved acute and long-term ablation outcomes. The routine adoption of this strategy should be considered to improve the outcomes of LV PM VA ablation.
Collapse
Affiliation(s)
- Tongshuai Chen
- National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Department of Cardiology, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Lujie Chang
- Department of Pediatric Cardiology, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Bing Rong
- Department of Geriatric Medicine, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Kai Zhang
- National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Department of Cardiology, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Guanqi Fan
- Department of Radiology, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Jing Kong
- National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Department of Cardiology, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Mingying Ling
- Department of Geriatric Medicine, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Qingyu Kong
- Department of Pediatric Cardiology, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Kellina Maduray
- National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Department of Cardiology, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Cuifen Zhao
- Department of Pediatric Cardiology, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Jingquan Zhong
- National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Department of Cardiology, Qilu Hospital of Shandong University, Jinan 250012, China
- Department of Cardiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Jinan 250012, China
| |
Collapse
|
4
|
Ma W, Qiu J, Lu F, Michael Shehata, Wang X, He L, Zhang F, Fan S, Zhang E, Wu D, Wang Z, Xu J. Catheter ablation of idiopathic left fascicular ventricular tachycardia: Implications of false tendons for mapping and ablation. J Cardiovasc Electrophysiol 2023; 34:673-681. [PMID: 36651353 DOI: 10.1111/jce.15822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/07/2023] [Accepted: 01/10/2023] [Indexed: 01/19/2023]
Abstract
INTRODUCTION The anatomical substrate for idiopathic left ventricular tachycardia (ILVT) remains speculative. Purkinje networks surrounding false tendons (FTs) might be involved in the reentrant circuit of ILVT. The objective was to evaluate the anatomical and electrophysiological features of false tendons FTs in relation to ILVT. METHODS Intracardiac echocardiography (ICE) was conducted on patients with ILVT. The relationship of the FTs with ILVT was determined using electro-anatomical mapping. RESULTS Electrophysiological evaluation and radiofrequency ablation were conducted in 23 consecutive patients with ILVT. FTs were identified in 19/23 cases (82.6%) with P1 potentials during VT recorded at the FT in 14 of these patients (73.7%). Three FT types were identified. In type 1, the FT attached the septum to the base of the posteromedial papillary muscle (PPM) (4/19); type 2 FTs ran between the septum and the PPM apex (3/19), while in type 3, the connection occurred between the septum and apex (11/19) or between the septum and the LV free wall (1/19). The effective ILVT ablation sites were situated at the FT-PPM (3/19) and the FT-septum (16/19) attachment sites. CONCLUSIONS This series demonstrates the association between Purkinje fibers and FTs during catheter ablation of ILVT and verifies that left ventricular FTs are an important substrate in this type of tachycardia.
Collapse
Affiliation(s)
- Wei Ma
- Tianjin Chest Hospital, School of Medicine, Nankai University, Tianjin University, Tianjin, China
| | - Jiuchun Qiu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology the Second Hospital of Tianjin Medical University, Tianjin, China
| | - Fengmin Lu
- Tianjin Chest Hospital, School of Medicine, Nankai University, Tianjin University, Tianjin, China
| | | | - Xunzhang Wang
- Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Le He
- Tianjin Chest Hospital, School of Medicine, Nankai University, Tianjin University, Tianjin, China
| | - Fan Zhang
- Tianjin Chest Hospital, School of Medicine, Nankai University, Tianjin University, Tianjin, China
| | - Shaobo Fan
- Tianjin Chest Hospital, School of Medicine, Nankai University, Tianjin University, Tianjin, China
| | - Enyuan Zhang
- Tianjin Chest Hospital, School of Medicine, Nankai University, Tianjin University, Tianjin, China
| | - Dongyan Wu
- Tianjin Chest Hospital, School of Medicine, Nankai University, Tianjin University, Tianjin, China
| | - Zulu Wang
- Department of Cardiology, General Hospital of Northern eater Command, Shenyang, China
| | - Jing Xu
- Tianjin Chest Hospital, School of Medicine, Nankai University, Tianjin University, Tianjin, China
| |
Collapse
|
5
|
Ma C, Chen T, Chen Y, Ge J, Han W, Wang Q, Zhong J. Understanding the scope of intracardiac echocardiography in catheter ablation of ventricular arrhythmia. Front Cardiovasc Med 2022; 9:1037176. [PMID: 36386380 PMCID: PMC9650380 DOI: 10.3389/fcvm.2022.1037176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 10/14/2022] [Indexed: 01/03/2024] Open
Abstract
Over the last few decades, catheter ablation has emerged as the first-line treatment for ventricular arrhythmias. However, detailed knowledge of cardiac anatomy during the surgery remains the prerequisite for successful ablation. Intracardiac echocardiography (ICE) is a unique imaging technique, which provides real-time visualization of cardiac structures, and is superior to other imaging modalities in terms of precise display of cardiac tissue characteristics as well as the orientation of anatomical landmarks. This article aimed to introduce the various advantages and limitations of ICE in the ablation of ventricular arrhythmias.
Collapse
Affiliation(s)
- Chuanzhen Ma
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Tongshuai Chen
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yanbo Chen
- Department of Cardiology, Weifang People’s Hospital, Weifang, China
| | - Junye Ge
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Wenqiang Han
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Qinhong Wang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jingquan Zhong
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Cardiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China
| |
Collapse
|
6
|
Sciacca V, Vogler J, Eitel C, Kuck KH, Tilz RR, Heeger CH. Ablation index-guided catheter ablation of incessant ventricular tachycardia originating from the anterolateral papillary muscle. Clin Res Cardiol 2021; 111:588-591. [PMID: 34724088 PMCID: PMC9054870 DOI: 10.1007/s00392-021-01923-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 08/13/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Vanessa Sciacca
- Medizinische Klinik II (Kardiologie, Angiologie, Intensivmedizin), Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein (UKSH), Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Julia Vogler
- Medizinische Klinik II (Kardiologie, Angiologie, Intensivmedizin), Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein (UKSH), Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Charlotte Eitel
- Medizinische Klinik II (Kardiologie, Angiologie, Intensivmedizin), Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein (UKSH), Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Karl-Heinz Kuck
- Medizinische Klinik II (Kardiologie, Angiologie, Intensivmedizin), Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein (UKSH), Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Roland Richard Tilz
- Medizinische Klinik II (Kardiologie, Angiologie, Intensivmedizin), Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein (UKSH), Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Christian-H Heeger
- Medizinische Klinik II (Kardiologie, Angiologie, Intensivmedizin), Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein (UKSH), Ratzeburger Allee 160, 23538, Lübeck, Germany.
| |
Collapse
|
7
|
Zhang J, Liang M, Wang Z, Zhang X, Fan J, Jia Y, Xiao F, Fu B, Zhang H, Huang J. Catheter ablation of premature ventricular complexes associated with left ventricular false tendons. Heart Rhythm 2021; 18:1968-1975. [PMID: 34214648 DOI: 10.1016/j.hrthm.2021.06.1197] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 06/25/2021] [Accepted: 06/25/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Clinical studies have suggested that there is a significant correlation between left ventricular (LV) false tendon and premature ventricular complexes (PVCs). OBJECTIVE This study aimed to investigate the electrophysiological characteristics and the outcome of radiofrequency catheter ablation (RFCA) for this category of PVCs. METHODS From a total of 2284 patients with idiopathic PVCs who underwent catheter ablation at 6 institutions in China, intracardiac echocardiography (ICE) was used during the procedure in 346 cases; 10 patients (2.9%) with PVCs associated with false tendon were retrospectively reviewed and enrolled in the present study. Activation mapping and pace mapping were performed to localize the origin of PVCs. ICE was used in all patients. If the false tendon was directly visualized and identified, we attempted to identify the distinct relationship with the PVC origin. RESULTS The PVCs were successfully eliminated by ablation in all patients. The target sites were confirmed to be related to false tendon. The origin of PVCs was located at the attachment of the false tendon to the papillary muscle, LV septum, or LV apex. At the target site, high-frequency Purkinje potentials were observed preceding local ventricular activation in 7 patients. CONCLUSION LV false tendon can be associated with PVCs, which can be cured by RFCA. An ICE-guided electroanatomical approach should be considered to improve the safety and feasibility of this procedure.
Collapse
Affiliation(s)
- Jinlin Zhang
- Department of Cardiology, Wuhan Asian Heart Hospital, Wuhan, China.
| | - Ming Liang
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Zulu Wang
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Xi Zhang
- Department of Cardiology, The First People's Hospital of Yunnan Province, Kunming, China
| | - Jie Fan
- Department of Cardiology, The First People's Hospital of Yunnan Province, Kunming, China
| | - Yuhe Jia
- Center for Cardiac Arrhythmia, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fangyi Xiao
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Biao Fu
- Department of Cardiology, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing, China
| | - Hao Zhang
- Department of Cardiology, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing, China
| | - Jin Huang
- Johnson & Johnson (Shanghai) Medical Equipment Co, Ltd, Shanghai, China
| |
Collapse
|
8
|
Muser D, Lavalle C, Guarracini F, Sassone B, Conte E, Magnani S, Notarstefano P, Barbato G, Sgarito G, Grandinetti G, Nucifora G, Ricci RP, Boriani G, De Ponti R, Casella M. Role of cardiac imaging in patients undergoing catheter ablation of ventricular tachycardia. J Cardiovasc Med (Hagerstown) 2020; 22:727-737. [PMID: 33136806 DOI: 10.2459/jcm.0000000000001121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Ventricular tachycardia is a major health issue in patients with structural heart disease (SHD). Implantable cardioverter defibrillator (ICD) therapy has significantly reduced the risk of sudden cardiac death (SCD) in such patients, but on the other hand, it has led to frequent ICD shocks as an emerging problem, being associated with poor quality of life, frequent hospitalizations and increased mortality. Myocardial scar plays a central role in the genesis and maintenance of re-entrant arrhythmias, as the coexistence of surviving myocardial fibres within fibrotic tissue leads to the formation of slow conduction pathways and to a dispersion of activation and refractoriness that constitutes the milieu for ventricular tachycardia circuits. Catheter ablation has repeatedly proven to be well tolerated and highly effective in treating VT and in the last two decades has benefited from continuous efforts to determine ventricular tachycardia mechanisms by integration with a wide range of invasive and noninvasive imaging techniques such as intracardiac echocardiography, cardiac magnetic resonance, multidetector computed tomography and nuclear imaging. Cardiovascular imaging has become a fundamental aid in planning and guiding catheter ablation procedures by integrating structural and electrophysiological information, enabling the ventricular tachycardia arrhythmogenic substrate to be characterized and effective ablation targets to be identified with increasing precision, and allowing the development of new ablation strategies with improved outcomes. In this review, we provide an overview of the role of cardiac imaging in patients undergoing catheter ablation of ventricular tachycardia.
Collapse
Affiliation(s)
- Daniele Muser
- Cardiac Electrophysiology, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Pennsylvania, USA.,Cardiology Division, Santa Maria della Misericordia Hospital, Udine
| | - Carlo Lavalle
- Department of Cardiology, Policlinico Universitario Umberto I, Roma
| | | | - Biagio Sassone
- Cardiology Division, SS.ma Annunziata Hospital, Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara
| | - Edoardo Conte
- Cardiovascular Imaging Area and Clinical Cardiology Unit, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Silvia Magnani
- Heart Rhythm Center, Langone Medical Center, New York University, New York, USA.,Ospedale San Paolo, Milan
| | | | | | - Giuseppe Sgarito
- Cardiology Division, ARNAS Ospedale Civico e Benfratelli, Palermo
| | | | - Gaetano Nucifora
- Cardiac Imaging Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena
| | - Roberto De Ponti
- Department of Heart and Vessels, Ospedale di Circolo & Macchi Foundation, University of Insubria, Varese
| | - Michela Casella
- Heart Rhythm Center, Centro Cardiologico Monzino IRCCS, Milan.,Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Ancona, Italy
| | | |
Collapse
|
9
|
Strategies for Catheter Ablation of Left Ventricular Papillary Muscle Arrhythmias. JACC Clin Electrophysiol 2020; 6:1381-1392. [DOI: 10.1016/j.jacep.2020.06.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 11/20/2022]
|
10
|
Raja DC, Rangaswamy VV, Abhilash SP, King K, Pathak RK. Electrophysiological Substrates in Papillary Muscle Arrhythmias – Implications for Catheter Ablation. ACTA ACUST UNITED AC 2020. [DOI: 10.17925/ejae.2020.6.1.32] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
11
|
Kautzner J, Peichl P. Papillary Muscle Ventricular Tachycardia or Ectopy: Diagnostics, Catheter Ablation and the Role of Intracardiac Echocardiography. Arrhythm Electrophysiol Rev 2019; 8:65-69. [PMID: 30918670 PMCID: PMC6434512 DOI: 10.15420/aer.2018.80.2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Ventricular arrhythmias originating from the papillary muscle of the left or right ventricle are specific clinical entities. They are usually focal in origin and can be identified by a characteristic ECG pattern. Intracardiac echocardiography appears to be the most suitable imaging method for assessment of the exact location of the focus at papillary muscles in association with activation mapping. We recently confirmed that ectopic foci were located within the distal, mid, or proximal (basal) third of the papillary muscle in 67%, 19%, and 14% of patients, respectively. Radiofrequency ablation has the potential to cure these specific arrhythmias. However, the procedure is usually challenging for catheter instability, despite navigation with intracardiac echocardiography. Cryoablation, which ensures catheter tip stability, could be a viable alternative in cases of the failure of radiofrequency catheter ablation.
Collapse
Affiliation(s)
- Josef Kautzner
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM) Prague, Czech Republic
| | - Petr Peichl
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM) Prague, Czech Republic
| |
Collapse
|
12
|
Rivera S, Vecchio N, Ricapito P. Anatomical Connections Between the Papillary Muscles and the Ventricular Myocardium. Circ Arrhythm Electrophysiol 2019; 12:e007004. [DOI: 10.1161/circep.118.007004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Santiago Rivera
- Buenos Aires Cardiovascular Institute (ICBA), Ciudad Autónoma de Buenos Aires, Argentina
| | - Nicolás Vecchio
- Buenos Aires Cardiovascular Institute (ICBA), Ciudad Autónoma de Buenos Aires, Argentina
| | - Paz Ricapito
- Buenos Aires Cardiovascular Institute (ICBA), Ciudad Autónoma de Buenos Aires, Argentina
| |
Collapse
|
13
|
Donnelly JA, Patel A, Beldner SJ. Ventricular Arrhythmia Originating from the Left Ventricular Papillary Muscles: Clinical Features and Technical Aspects. J Innov Card Rhythm Manag 2018; 9:3006-3013. [PMID: 32477795 PMCID: PMC7252730 DOI: 10.19102/icrm.2018.090202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 09/22/2017] [Indexed: 11/08/2022] Open
Abstract
The discovery, characterization, and ablation of the papillary muscles have evolved rapidly since the initial description in 2008. New innovations in pacemapping, intracardiac imaging, ablation catheters, and ablation methodologies have dramatically impacted the approach to the treatment of papillary muscle ventricular arrhythmias. This review provides an up-to-date summary of these methods, as well as guidance on how to integrate them into clinical practice.
Collapse
Affiliation(s)
- Joseph A Donnelly
- Department of Cardiology, Northwell Health System, Manhasset, NY, USA
| | - Apoor Patel
- Department of Cardiology, Northwell Health System, Manhasset, NY, USA
| | - Stuart J Beldner
- Department of Cardiology, Northwell Health System, Manhasset, NY, USA
| |
Collapse
|
14
|
Miranda-Arboleda AF, Correa R, Saenz G, Agudelo JF, Ramírez JD. Young Male With Incessantly Wide Complex Tachycardia: What Is the Substrate of the Arrhythmia? Circulation 2018; 137:300-302. [PMID: 29335290 DOI: 10.1161/circulationaha.117.032445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Andrés F Miranda-Arboleda
- Department of Cardiology, Faculty of Medicine, Universidad de Antioquia, Medellín, Colombia (A.F.M.-A.)
| | - Rafael Correa
- Electrophysiology and Arrhythmia Service, Clínica CardioVID, Medellín, Colombia (R.C, G.S., J.F.A., J.D.R.)
| | - Gloria Saenz
- Electrophysiology and Arrhythmia Service, Clínica CardioVID, Medellín, Colombia (R.C, G.S., J.F.A., J.D.R.)
| | - Juan F Agudelo
- Electrophysiology and Arrhythmia Service, Clínica CardioVID, Medellín, Colombia (R.C, G.S., J.F.A., J.D.R.)
| | - Juan D Ramírez
- Electrophysiology and Arrhythmia Service, Clínica CardioVID, Medellín, Colombia (R.C, G.S., J.F.A., J.D.R.)
| |
Collapse
|
15
|
Eitel C, Tilz RR. Do we need intracardiac echo to guide ablation of ventricular arrhythmias from the papillary muscles? Europace 2017; 19:1073-1074. [PMID: 27485576 DOI: 10.1093/europace/euw135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Charlotte Eitel
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Ratzeburger Allee 160, Lübeck 23538, Germany
| | - Roland R Tilz
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Ratzeburger Allee 160, Lübeck 23538, Germany
| |
Collapse
|
16
|
Naksuk N, Kapa S, Asirvatham SJ. Spectrum of Ventricular Arrhythmias Arising from Papillary Muscle in the Structurally Normal Heart. Card Electrophysiol Clin 2017; 8:555-65. [PMID: 27521089 DOI: 10.1016/j.ccep.2016.04.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Papillary muscle is an endocavitary structure that can give rise to ventricular arrhythmias in a structurally normal heart. Its manifestation is generally benign. The papillary muscle's complex anatomy and the presence of intermixed Purkinje fibers can create a substrate for idiopathic ventricular fibrillation. Although differentiating ventricular arrhythmias originating from the papillary muscle and the fascicles is challenging and not always possible, the distinction may be helpful for planning ablation. The propensity for difficulty with ablation of papillary arrhythmias results in a variable success rate. Improvement in techniques to stabilize the catheter, use of imaging, and methods of energy delivery are required to improve ablation outcomes.
Collapse
Affiliation(s)
- Niyada Naksuk
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Suraj Kapa
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Samuel J Asirvatham
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA; Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
| |
Collapse
|
17
|
Ng FS, Rashid M, Lim ZL, Lim PB. Mapping Signatures of Ventricular Ectopic Activity of Endocavitary Origin. JACC Clin Electrophysiol 2017; 3:186-188. [PMID: 29759393 DOI: 10.1016/j.jacep.2016.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 08/02/2016] [Accepted: 08/04/2016] [Indexed: 11/15/2022]
Affiliation(s)
- Fu Siong Ng
- Imperial College, London, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom.
| | | | - Zhen Lin Lim
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Phang Boon Lim
- Imperial College, London, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom
| |
Collapse
|
18
|
Asirvatham SJ, Stevenson WG. Expecting the Expected. Circ Arrhythm Electrophysiol 2016; 9:CIRCEP.116.004726. [DOI: 10.1161/circep.116.004726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 11/21/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Samuel J. Asirvatham
- From the Division of Cardiovascular Diseases, Department of Medicine and Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN (S.J.A.); and Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA (W.G.S.)
| | - William G. Stevenson
- From the Division of Cardiovascular Diseases, Department of Medicine and Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN (S.J.A.); and Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA (W.G.S.)
| |
Collapse
|
19
|
Wo HT, Liao FC, Chang PC, Chou CC, Wen MS, Wang CC, Yeh SJ. Circumferential ablation at the base of the left ventricular papillary muscles: A highly effective approach for ventricular arrhythmias originating from the papillary muscles. Int J Cardiol 2016; 220:876-82. [DOI: 10.1016/j.ijcard.2016.06.151] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 06/19/2016] [Accepted: 06/24/2016] [Indexed: 10/21/2022]
|
20
|
Rivera S, Ricapito MDLP, Tomas L, Parodi J, Bardera Molina G, Banega R, Bueti P, Orosco A, Reinoso M, Caro M, Belardi D, Albina G, Giniger A, Scazzuso F. Results of Cryoenergy and Radiofrequency-Based Catheter Ablation for Treating Ventricular Arrhythmias Arising From the Papillary Muscles of the Left Ventricle, Guided by Intracardiac Echocardiography and Image Integration. Circ Arrhythm Electrophysiol 2016; 9:e003874. [PMID: 27069089 DOI: 10.1161/circep.115.003874] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 02/25/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Catheter radiofrequency ablation of ventricular arrhythmias (VAs) arising from the left ventricle's papillary muscles has been associated with inconsistent results. The use of cryoenergy versus radiofrequency has not been compared yet. This study compares outcomes and complications of catheter ablation of VA from the papillary muscles of the left ventricle with either cryoenergy or radiofrequency. METHODS AND RESULTS Twenty-one patients (40±12 years old; 47% males; median ejection fraction 59±7.3%) with drug refractory premature ventricular contractions or ventricular tachycardia underwent catheter cryoablation or radiofrequency ablation. VAs were localized using 3-dimensional mapping, multidetector computed tomography, and intracardiac echocardiography, with arrhythmia foci being mapped at either the anterolateral papillary muscle or posteromedial papillary muscles of the left ventricle. Focal ablation was performed using an 8-mm cryoablation catheter or a 4-mm open-irrigated radiofrequency catheter, via transmitral approach. Acute success rate was 100% for cryoenergy (n=12) and 78% for radiofrequency (n=9; P=0.08). Catheter stability was achieved in all patients (100%) treated with cryoenergy, and only in 2 (25%) patients treated with radiofrequency (P=0.001). Incidence of multiple VA morphologies was observed in 7 patients treated with radiofrequency (77.7%), whereas none was observed in those treated with cryoenergy (P=0.001). VA recurrence at 6 months follow-up was 0% for cryoablation and 44% for radiofrequency (P=0.03). CONCLUSIONS Cryoablation was associated with higher success rates and lower recurrence rates than radiofrequency catheter ablation, better catheter stability, and lesser incidence of polymorphic arrhythmias.
Collapse
Affiliation(s)
- Santiago Rivera
- From the Cardiovascular Institute of Buenos Aires (ICBA), Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina.
| | - Maria de la Paz Ricapito
- From the Cardiovascular Institute of Buenos Aires (ICBA), Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina
| | - Leandro Tomas
- From the Cardiovascular Institute of Buenos Aires (ICBA), Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina
| | - Josefina Parodi
- From the Cardiovascular Institute of Buenos Aires (ICBA), Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina
| | - Guillermo Bardera Molina
- From the Cardiovascular Institute of Buenos Aires (ICBA), Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina
| | - Rodrigo Banega
- From the Cardiovascular Institute of Buenos Aires (ICBA), Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina
| | - Pablo Bueti
- From the Cardiovascular Institute of Buenos Aires (ICBA), Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina
| | - Agustin Orosco
- From the Cardiovascular Institute of Buenos Aires (ICBA), Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina
| | - Marcelo Reinoso
- From the Cardiovascular Institute of Buenos Aires (ICBA), Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina
| | - Milagros Caro
- From the Cardiovascular Institute of Buenos Aires (ICBA), Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina
| | - Diego Belardi
- From the Cardiovascular Institute of Buenos Aires (ICBA), Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina
| | - Gaston Albina
- From the Cardiovascular Institute of Buenos Aires (ICBA), Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina
| | - Alberto Giniger
- From the Cardiovascular Institute of Buenos Aires (ICBA), Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina
| | - Fernando Scazzuso
- From the Cardiovascular Institute of Buenos Aires (ICBA), Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina
| |
Collapse
|
21
|
Proietti R, Rivera S, Dussault C, Essebag V, Bernier ML, Ayala-Paredes F, Badra-Verdu M, Roux JF. Intracardiac echo-facilitated 3D electroanatomical mapping of ventricular arrhythmias from the papillary muscles: assessing the 'fourth dimension' during ablation. Europace 2016; 19:21-28. [PMID: 27485578 DOI: 10.1093/europace/euw099] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 02/15/2016] [Indexed: 11/14/2022] Open
Abstract
AIMS Ventricular arrhythmias (VA) originating from a papillary muscle (PM) have recently been described as a distinct clinical entity with peculiar features that make its treatment with catheter ablation challenging. Here, we report our experience using an intracardiac echo-facilitated 3D electroanatomical mapping approach in a case series of patients undergoing ablation for PM VA. METHODS AND RESULTS Sixteen patients who underwent catheter ablation for ventricular tachycardia (VT) or symptomatic premature ventricular contractions originating from left ventricular PMs were included in the study. A total of 24 procedures (mean 1.5 per patient) were performed: 15 using a retrograde aortic approach and 9 using a transseptal approach. Integrated intracardiac ultrasound for 3D electroanatomical mapping was used in 15 of the 24 procedures. The posteromedial PM was the most frequent culprit for the clinical arrhythmia, and the body was the part of the PM most likely to be the successful site for ablation. The site of ablation was identified based on the best pace map matching the clinical arrhythmia and the site of earliest the activation. At a mean follow-up of 10.5 ± 7 months, only two patients had recurrent arrhythmias following a repeat ablation procedure. CONCLUSION An echo-facilitated 3D electroanatomical mapping allows for real-time creation of precise geometries of cardiac chambers and endocavitary structures. This is useful during procedures such as catheter ablation of VAs originating from PMs, which require detailed representation of anatomical landmarks. Routine adoption of this technique should be considered to improve outcomes of PM VA ablation.
Collapse
Affiliation(s)
- Riccardo Proietti
- McGill University Health Center, Montreal, QC, Canada.,Cardiology Department, Luigi Sacco Hospital, Milan, Italy
| | - Santiago Rivera
- Cardiology Division, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Charles Dussault
- Cardiology Division, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada
| | - Vidal Essebag
- McGill University Health Center, Montreal, QC, Canada.,Hôpital Sacré-Coeur de Montréal, Montreal, QC, Canada
| | | | - Felix Ayala-Paredes
- Cardiology Division, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada
| | - Mariano Badra-Verdu
- Cardiology Division, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada
| | - Jean-François Roux
- Cardiology Division, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada .,CHUS - Hôpital Fleurimont, 3001, 12e Avenue Nord, Sherbrooke, QC, Canada J1H N4
| |
Collapse
|
22
|
Chang YT, Lin YJ, Chung FP, Lo LW, Hu YF, Chang SL, Chao TF, Liao JN, Tuan TC, Lin CY, Wang HY, Jhuo SJ, Lin CH, Suresh A, Walia R, Te ALD, Yamada S, Chen SA. Ablation of ventricular arrhythmia originating at the papillary muscle using an automatic pacemapping module. Heart Rhythm 2016; 13:1431-40. [DOI: 10.1016/j.hrthm.2016.03.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Indexed: 11/16/2022]
|
23
|
Rivera S, de la Paz Ricapito M, Espinoza J, Belardi D, Albina G, Giniger A, Roux JF, Ayala-Paredes F, Scazzuso F. Cryoablation for Ventricular Arrhythmias Arising From the Papillary Muscles of the Left Ventricle Guided by Intracardiac Echocardiography and Image Integration. JACC Clin Electrophysiol 2015; 1:509-516. [PMID: 29759404 DOI: 10.1016/j.jacep.2015.07.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 07/27/2015] [Accepted: 07/31/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This case series reports outcomes and complications of catheter cryoablation at the papillary muscles (PM) of the left ventricle (LV). BACKGROUND 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. METHODS 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. RESULTS 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 at the site of effective lesion. All VAs arising from the base of the PM showed Purkinje potentials. There were no post-procedure complications. VA recurred in 1 patient. CONCLUSIONS Cryoablation for arrhythmias arising from the PMs of the LV can be performed, and is a safe and effective alternative energy source for ablation.
Collapse
Affiliation(s)
- Santiago Rivera
- Cardiovascular Institute of Buenos Aires (ICBA), Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina.
| | - Maria de la Paz Ricapito
- Cardiovascular Institute of Buenos Aires (ICBA), Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina
| | - Juan Espinoza
- Cardiovascular Institute of Buenos Aires (ICBA), Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina
| | - Diego Belardi
- Cardiovascular Institute of Buenos Aires (ICBA), Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina
| | - Gaston Albina
- Cardiovascular Institute of Buenos Aires (ICBA), Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina
| | - Alberto Giniger
- Cardiovascular Institute of Buenos Aires (ICBA), Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina
| | - Jean-François Roux
- Centre Hospitalaire Universitaire de Sherbrooke (CHUS), Sherbrooke, Quebec, Canada
| | - Felix Ayala-Paredes
- Centre Hospitalaire Universitaire de Sherbrooke (CHUS), Sherbrooke, Quebec, Canada
| | - Fernando Scazzuso
- Cardiovascular Institute of Buenos Aires (ICBA), Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina
| |
Collapse
|
24
|
Iyer V, Garan AR, Mancini D, Garan H, Whang W. Ablation of Ventricular Tachycardia Originating From the Papillary Muscle of the Left Ventricle Early After Heart Transplantation. Circ Heart Fail 2014; 7:223-4. [DOI: 10.1161/circheartfailure.113.000693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Vivek Iyer
- From the Columbia University Medical Center, New York, NY
| | | | - Donna Mancini
- From the Columbia University Medical Center, New York, NY
| | - Hasan Garan
- From the Columbia University Medical Center, New York, NY
| | - William Whang
- From the Columbia University Medical Center, New York, NY
| |
Collapse
|
25
|
Syed FF, Hai JJ, Lachman N, DeSimone CV, Asirvatham SJ. The infrahisian conduction system and endocavitary cardiac structures: relevance for the invasive electrophysiologist. J Interv Card Electrophysiol 2013; 39:45-56. [PMID: 24322419 DOI: 10.1007/s10840-013-9858-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 10/24/2013] [Indexed: 01/27/2023]
Affiliation(s)
- Faisal F Syed
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | | | | | | | | |
Collapse
|
26
|
Killu AM, Syed FF, Wu P, Asirvatham SJ. Refractory inappropriate sinus tachycardia successfully treated with radiofrequency ablation at the arcuate ridge. Heart Rhythm 2012; 9:1324-7. [DOI: 10.1016/j.hrthm.2012.03.044] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Indexed: 11/28/2022]
|
27
|
Del Carpio Munoz F, Buescher TL, Asirvatham SJ. Teaching Points With 3-Dimensional Mapping of Cardiac Arrhythmia. Circ Arrhythm Electrophysiol 2011; 4:e72-5. [DOI: 10.1161/circep.110.960369] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Freddy Del Carpio Munoz
- From the Division of Cardiovascular Diseases (F.D.C.M., T.L.B., S.J.A.) and the Department of Pediatrics and Adolescent Medicine (S.J.A.), Mayo Clinic, Rochester, MN
| | - Traci L. Buescher
- From the Division of Cardiovascular Diseases (F.D.C.M., T.L.B., S.J.A.) and the Department of Pediatrics and Adolescent Medicine (S.J.A.), Mayo Clinic, Rochester, MN
| | - Samuel J. Asirvatham
- From the Division of Cardiovascular Diseases (F.D.C.M., T.L.B., S.J.A.) and the Department of Pediatrics and Adolescent Medicine (S.J.A.), Mayo Clinic, Rochester, MN
| |
Collapse
|
28
|
Del Carpio Munoz F, Buescher TL, Asirvatham SJ. Teaching Points With 3-Dimensional Mapping of Cardiac Arrhythmias. Circ Arrhythm Electrophysiol 2011; 4:e11-4. [DOI: 10.1161/circep.110.960344] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Freddy Del Carpio Munoz
- From the Division of Cardiovascular Diseases (F.D.C.M., T.L.B., S.J.A.) and the Department of Pediatrics and Adolescent Medicine (S.J.A.), Mayo Clinic, Rochester, MN
| | - Traci L. Buescher
- From the Division of Cardiovascular Diseases (F.D.C.M., T.L.B., S.J.A.) and the Department of Pediatrics and Adolescent Medicine (S.J.A.), Mayo Clinic, Rochester, MN
| | - Samuel J. Asirvatham
- From the Division of Cardiovascular Diseases (F.D.C.M., T.L.B., S.J.A.) and the Department of Pediatrics and Adolescent Medicine (S.J.A.), Mayo Clinic, Rochester, MN
| |
Collapse
|