Ablation of ventricular arrhythmia originating at the papillary muscle using an automatic pacemapping module

Chang, Yao Ting; Lin, Yenn Jiang; Chung, Fa Po; Lo, Li Wei; Hu, Yu Feng; Chao, Tze Fan; Liao, Jo Nan; Tuan, Ta Chuan; Wang, Hsin‐Yi; Jhuo, Shih-Jie; Lin, Chih‐Yuan; Allamsetty, Suresh; Walia, Rohit; Chung, Fa‐Po; Yamada, Shinya; Chen, Shih Ann

doi:10.1016/j.hrthm.2016.03.017

Cited by 10 publications

(29 citation statements)

References 23 publications

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“…18,24 With expanded use of cryoablation, circumferential ablation, and automatic pacemapping, current generation success rates are quoted to be as high as 90% to 100%. 27,29,31 These advances have rapidly transitioned ablation of papillary VA from one of the least successful ablation procedures to one of high probability of cure. The lessons learned from papillary muscle arrhythmia are being applied to other endocavitary structures and may help to improve procedural success rates elsewhere in the future.…”

Section: Our Method/summarymentioning

confidence: 99%

“…The authors reported a 100% long-term success rate. 27 The weakness of pacemapping, which has been historically observed, is likely to be multifactorial. The two major limiting factors are technology and patient anatomy.…”

Section: Pacemappingmentioning

confidence: 99%

“…Since 2008, pacemapping has improved from initially being visually guided, to currently employing computer-assisted matching algorithms. This is reflected in the increasing rates of ablation success seen over time, which are best demonstrated in the study by Chang et al 27 The second factor is the inherent anatomic limitations of pacemapping in the papillary muscle. The normal vigorous contractions of the papillary muscles limit catheter placement and stability, and their deep myocardial nature, as well as multiple exit sites, further limits the accuracy of pacemapping.…”

Section: Pacemappingmentioning

confidence: 99%

See 2 more Smart Citations

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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Section: Our Method/summarymentioning

confidence: 99%

Section: Pacemappingmentioning

confidence: 99%

Section: Pacemappingmentioning

confidence: 99%

See 1 more Smart Citation

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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“…In that study, morphological alterations were noticed in 92% of patients, requiring ablation at different exit sites. [24] This suggests that the source is in the middle or apical portion of the PM, and pace mapping around the base of the PM identifies variable exits. Some groups advocated circumferential ablation around the base of the PM as a successful strategy.…”

Section: Catheter Ablationmentioning

confidence: 99%

Papillary Muscle Ventricular Tachycardia or Ectopy: Diagnostics, Catheter Ablation and the Role of Intracardiac Echocardiography

Kautzner

Peichl

2019

Arrhythm Electrophysiol Rev

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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.

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“…Similarly, strategy using automatic matching algorithm to identify various exits from the PM by pacemapping supports the view that the source of ectopy is localized higher on the PM. 16…”

Section: Tip Versus Base As the Source Of The Ectopymentioning

confidence: 99%

The tip of the muscle is a dominant location of ventricular ectopy originating from papillary muscles in the left ventricle

Peichl

Wichterle

Čihák

et al. 2017

Cardiovasc electrophysiol

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Introduction: Frequent ventricular premature complexes (VPCs) may cause symptoms and/or lead to deterioration of LV systolic function. Although frequent VPCs may be abolished by catheter ablation, it may be challenging in case of their origin from the LV papillary muscles (PMs). Our collaborative study aimed to analyze in detail the site of origin and the outcome of ablation. Methods:Consecutive 34 patients (males: 68%; aged 62 ± 12 years; LV ejection fraction: 50 ± 9%) undergoing catheter ablation of VPCs originating from PMs were included. All procedures were guided by intracardiac echocardiography. Results:The size and shape of PMs were highly variable. The length of anterolateral and posteromedial PM was 23 ± 4 mm and 28 ± 7 mm, respectively. In about one-third of patients, the PM was formed by two distinctly separate heads. The ectopic foci were located on anterolateral, posteromedial or both PM in 35%, 56% and 9% of cases, respectively. Their location was found within the distal, mid, or proximal (basal) third of PM in the 67%, 19%, and 14%, respectively. A total of 86% of PM foci were acutely abolished and long-term success was achieved in 65% of patients. Absence of VPCs of other morphologies and a high burden of ectopic activity before ablation were associated with favorable clinical outcome. Conclusion:VPCs originate predominantly from the distal portion of the PM. This knowledge may facilitate the mapping in patients with infrequent ectopic beats. Intracardiac echocardiography is of crucial importance for navigation of the ablation catheter and for assessment of its stability at PM target sites.

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Ablation of ventricular arrhythmia originating at the papillary muscle using an automatic pacemapping module

Cited by 10 publications

References 23 publications

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

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

Papillary Muscle Ventricular Tachycardia or Ectopy: Diagnostics, Catheter Ablation and the Role of Intracardiac Echocardiography

The tip of the muscle is a dominant location of ventricular ectopy originating from papillary muscles in the left ventricle

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