Usefulness of pace mapping in catheter ablation of left ventricular papillary muscle ventricular arrhythmias with a preferential conduction

Abstract

When an M-PM with latency was recorded in LVPM VAs, RFCA at that site was highly successful. Attention should be paid to latency as well as the score during pace mapping of LVPM VAs.

2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias

“…In some patients, the VA can originate in a deep intramural location, and the electrograms with the earliest activation time can have a far-field appearance or be difficult to define. In these patients, ablation at sites with a matching pace map and prolonged S-QRS might be successful, although longer and higher-powered RF application might be necessary ( S9.3.2.16 ).…”

Electrophysiological Substrates in Papillary Muscle Arrhythmias – Implications for Catheter Ablation

“…EUROPEAN JOURNAL OF ARRHYTHMIA & ELECTROPHYSIOLOGY activation map and when ablation at earliest activation sites fail. Good pace maps can be obtained at multiple sites remote to the earliest activation sites and ablation at these sites might be successful when VAs are not inducible 35. …”

Catheter ablation for papillary muscle arrhythmias: A systematic review

“…[19][20][26][27][28][31][32][33] Intracardiac echocardiography (ICE) was used to guide mapping and ablation in 19 studies (86.4%). [14][15][16][17][18][19][20][21][22][23][25][26][27][28][29][30][31][32][33] In 13 studies ICE assisted all procedures, [15][16][19][20][21][22][23]25,[28][29][30][31]33 whereas in six studies only a portion of the procedure was ICE-guided. 14,[17][18][26][27]32 Three dimensional electroanatomical mapping system assisted the procedure in all cases (Biosense Webster CARTO system in 16 studies, 14,[16][17]…”

“…Access to the left ventricle was obtained through retrograde crossing the aortic valve in six studies [13][14][17][18]24,27 or trans-septal puncture in two studies. [19][20] In 10 studies both the approaches were used, 15,23,[25][26][28][29][30][31][32][33] and in three studies the approach used for mapping and ablating the PM-VAs was not reported. 16,[21][22] Mapping and ablation catheters features were reported in 95% of the studies (n = 20, Table 2).…”

“…Irrigated catheters were used in 11 studies, 13,16,[19][20][22][23][25][26][27][30][31][32][33] whereas in nine reports the procedure was performed using a combination of irrigated or nonirrigated. 14,[17][18]21,24,[28][29] A combination of catheters with and without CFS capabilities were used in seven studies, [26][27][28][30][31][32][33] whereas in 13 studies ablation was performed with catheters without CFS capabilities. [13][14][15][16][17][18][19][20][21][22][23][24][25] During activation mapping, the mean pre-QRS activation time was 29.6 ± 10.9 ms (Table 2).…”