Long‐term study on electrophysiological characteristics and catheter ablation of idiopathic ventricular arrhythmias originating from the left ventricular posterior papillary muscles guided by intracardiac ultrasound

Abstract

Background This study aimed to investigate the electrophysiological characteristics of idiopathic ventricular arrhythmias (VAs) originating from the left ventricular posterior papillary muscles (LPPM) and explore the efficiency of catheter ablation using three‐dimensional intracardiac ultrasound technology. Methods Twenty‐seven cases of premature ventricular contraction/ventricular tachycardia (PVC/VT) originating from the left ventricular posterior papillary muscles were recorded from July 2015 to June 2019 in the Central Hospital of Shengli Oil Field and the First Affiliated Hospital of Zhengzhou University. Electrophysiological mapping and radiofrequency catheter ablation (RFCA) were performed using three‐dimensional intracardiac ultrasound technology. The characteristics of the body surface and intracavity electrocardiogram were analyzed. All cases were followed up for 24 months after the operation. Results The VAs of all 27 cases were successfully eliminated by catheter ablation. QRS complexes were observed with a right bundle branch block (RBBB) pattern and a steep slope in the initial segment. Lead I appeared with an Rs pattern, and inferior leads (lead II, III, and aVF) were usually with an S wave. The lead aVR appeared with a qR pattern, while the R wave was commonly found in aVL. The main wave in leads V1‐V3 was positive but negative in V5 and V6. Conclusion Ventricular arrhythmias originating from the left ventricular posterior papillary muscles have similar electrophysiological characteristics. The origin site was accurately located using three‐dimensional intracardiac ultrasound technology. Catheter ablation effectively eliminated VAs.

Continuing efforts to characterize and treat extrasystoles originating from the left ventricle

“…After a 24-month follow-up period, 26/27 patients had no primary symptoms or VA, and one patient experienced PVCs with differing ECG morphology. (Liu et al, 2022) This study supports the need for the utilization of both ul- The target ablation site was determined by identifying the earliest activation point during excitation mapping. This was difficult to accomplish due to the varying morphology of the papillary muscle and required detailed mapping.…”

“…After a 24‐month follow‐up period, 26/27 patients had no primary symptoms or VA, and one patient experienced PVCs with differing ECG morphology. (Liu et al, 2022 )…”

“…As mentioned in their paper, the anatomy of the papillary muscle along with catheter‐tissue contact was delineated with ICE imaging, further enhancing their ablation success. (Liu et al, 2022 )…”

“…In this series, the effective target ablation point was mostly found in the middle of the papillary muscle (20/36 patients). (Liu et al, 2022 ) However, it is important to note the limitations of activation mapping for nonfocal, re‐entrant circuits. Just as with the observed variations in papillary muscle anatomy, there is described variability in the left ventricular Purkinje network system, particularly in relation to septal branches.…”