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.
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.
Authors: Santiago Rivera; Maria de la Paz Ricapito; Josefina Parodi; Pablo Spaletra; Gaston Albina; Alberto Giniger; Fernando Scazzuso Journal: HeartRhythm Case Rep Date: 2016-08-18
Authors: Vanessa Sciacca; Julia Vogler; Charlotte Eitel; Karl-Heinz Kuck; Roland Richard Tilz; Christian-H Heeger Journal: Clin Res Cardiol Date: 2021-11-01 Impact factor: 5.460
Authors: Santiago Rivera; Leandro Tomas; Maria de la Paz Ricapito; Vecchio Nicolas; Marcelo Reinoso; Milagros Caro; Ignacio Mondragon; Gaston Albina; Alberto Giniger; Fernando Scazzuso Journal: J Arrhythm Date: 2018-11-18