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

Rivera, Santiago; Ricapito, María de la Paz; Espinoza, Juan; Belardi, Diego; Albina, Gastón; Giniger, Alberto; Roux, Jean‐François; Ayala‐Paredes, Felix; Scazzuso, Fernando

doi:10.1016/j.jacep.2015.07.012

Cited by 29 publications

(31 citation statements)

References 30 publications

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“…3 There is yet no data available comparing results of both cryoenergy and radiofrequency for catheter cryoablation of PM-related arrhythmias.…”

Section: See Editorial By Latchamsetty and Bogunmentioning

confidence: 99%

“…3 There is yet no data available comparing results of both cryoenergy and radiofrequency for catheter cryoablation of PM-related arrhythmias.This study compares procedural outcomes and recurrence rate after catheter cryoablation or radiofrequency ablation for the treatment of ventricular tachycardia (VT) and premature ventricular complexes (PVCs) localized at the PMs of the LV, with the aid of intracardiac echocardiography (ICE) and image integration. …”

mentioning

confidence: 99%

“…Patients who developed multiple VA morphologies during follow-up were excluded from this study. Some patients included in prior publications 3 were not eligible for inclusion due to VAs from multiple sites, not limited to the PMs. Neither was related to the ablation procedure.…”

mentioning

confidence: 99%

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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

Rivera

Ricapito

Linkevičius

et al. 2016

Circ: Arrhythmia and Electrophysiology

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T he papillary muscles (PMs) from the left ventricle (LV) have been shown to be a potential site of origin of ventricular arrhythmias (VAs) in patients with and without structural heart disease.1 Catheter ablation has been described as an effective treatment for these arrhythmias, although radiofrequency delivery at these regions has been associated with poor manipulation and catheter stability compared with other VAs. 2 See Editorial by Latchamsetty and BogunPrevious data on catheter cryoablation of PMs VAs showed high-success and low complication rates. 3 There is yet no data available comparing results of both cryoenergy and radiofrequency for catheter cryoablation of PM-related arrhythmias.This study compares procedural outcomes and recurrence rate after catheter cryoablation or radiofrequency ablation for the treatment of ventricular tachycardia (VT) and premature ventricular complexes (PVCs) localized at the PMs of the LV, with the aid of intracardiac echocardiography (ICE) and image integration. MethodsA total of 21 patients with recurrent VAs originating at the PMs of the LV were identified from retrospective review of 189 consecutive patients (men 52%, age 44 years, range 28-54 years) with symptomatic sustained VT (n=58), nonsustained VT (n=40), or PVC (n=91) referred for catheter ablation to the Buenos Aires Cardiovascular Institute (Buenos Aires, Argentina) between January 2014 and January 2016. Scar-related VT was observed in 45 patients (24%). The sites of origin of idiopathic VAs included the right ventricular (RV) outflow tract in 82 (43%), aortomitral continuity in 24 (13%), posteromedial PM (PMPM) in 19 (10%), anterolateral PM (ALPM) in 3 (1.5%), aortic root in 3 (1.5%), fascicles of the left bundle branch in 2 (1%), mitral annulus in 1 (0.5%), and other sites in 11 (6%). This study retrospectively included 21 patients with symptomatic, drug refractory, and single morphology VAs originated at the PMs of the LV. The institutional review committee approved the study and © 2016 American Heart Association, Inc. Circ Arrhythm Electrophysiol Original ArticleBackground-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 cryoa...

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“…3 There is yet no data available comparing results of both cryoenergy and radiofrequency for catheter cryoablation of PM-related arrhythmias.…”

Section: See Editorial By Latchamsetty and Bogunmentioning

confidence: 99%

mentioning

confidence: 99%

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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

Rivera

Ricapito

Linkevičius

et al. 2016

Circ: Arrhythmia and Electrophysiology

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“…Catheter ablation has been described as an effective treatment, although radiofrequency (RF) delivery at these regions has been associated with poor catheter stability and high recurrence . Cryo‐energy can provide stable contact and lower recurrence rates . Nevertheless, information regarding PM VAs ablation approaches is still lacking.…”

Section: Introductionmentioning

confidence: 99%

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

Rivera

Linkevičius

Ricapito

et al. 2018

Journal of Arrhythmia

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BackgroundCatheter 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.MethodsFifty‐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.ResultsAcute success rate was 83% for Non‐CFS RF/CTII; 100% for CRYO/CTII (n = 16) and CFS RF/ICE3D (n = 14) (P = 0.03). Catheter stability was achieved in all patients treated with Cryo/CTII. VA recurrence at 12 months follow‐up was 48% (n = 11) for Non‐CFS RF/CTII; 19% (n = 3) for CRYO/CTII; and 7% (n = 1) for CFS RF/ICE3D (P = 0.02).ConclusionsNon‐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.

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“…28 Ten patients underwent cryoablation for symptomatic, drug-refractory VAs using a transmitral approach. Cryoenergy was delivered to the earliest site of bipolar activity, earliest QS unipolar patterns, or earliest Purkinje network activity preceding the QRS.…”

Section: Early Potentialsmentioning

confidence: 99%

Ventricular Arrhythmia Originating from the Left Ventricular Papillary Muscles: Clinical Features and Technical Aspects

Donnelly¹,

Patel²,

Beldner³

2018

J Innov Cardiac Rhythm Manage

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

Abstract: Cryoablation for arrhythmias arising from the PMs of the LV can be performed, and is a safe and effective alternative energy source for ablation.

Cited by 29 publications

References 30 publications

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

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

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

Ventricular Arrhythmia Originating from the Left Ventricular Papillary Muscles: Clinical Features and Technical Aspects

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