136-34: Cryo-energy Vs Radiofrequency Based Catheter Ablation for Treating Ventricular Arrhythmias Arising from the Papillary Muscles of the Left Ventricle, Guided by Intracardiac Echocardiography and Image Integration

Papillary muscles (PMs) were reported to be origin of ventricular arrhythmia (VA). Radiofrequency (RF) ablation was reported to be acutely effective in eliminating VA. However, the recurrence rate is high. Recently, cryoablation guided by intracardiac echocardiography, 3-dimensional mapping system, and image integration was introduced as alternative strategy for this challenging ablation. We present a case of ventricular tachycardia originating from anterior PM of left ventricle treated by cryoablation guided only by intracardiac echocardiography.

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

Journal of Arrhythmia ◽

10.1002/joa3.12137 ◽

2018 ◽

Vol 35 (1) ◽

pp. 99-108

Author(s):

Santiago Rivera ◽

Leandro Tomas ◽

Maria de la Paz Ricapito ◽

Vecchio Nicolas ◽

Marcelo Reinoso ◽

...

Keyword(s):

Catheter Ablation ◽

Left Ventricle ◽

Ventricular Arrhythmias ◽

Papillary Muscles

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Idiopathic Ventricular Arrhythmias Originating from the Papillary Muscles in the Left Ventricle: Prevalence, Electrocardiographic and Electrophysiological Characteristics, and Results of the Radiofrequency Catheter Ablation

Journal of Cardiovascular Electrophysiology ◽

10.1111/j.1540-8167.2009.01594.x ◽

2010 ◽

Vol 21 (1) ◽

pp. 62-69 ◽

Cited By ~ 79

Author(s):

TAKUMI YAMADA ◽

HARISH DOPPALAPUDI ◽

HUGH T. McELDERRY ◽

TARO OKADA ◽

YOSHIMASA MURAKAMI ◽

...

Keyword(s):

Catheter Ablation ◽

Left Ventricle ◽

Ventricular Arrhythmias ◽

Radiofrequency Catheter Ablation ◽

Papillary Muscles

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

Arrhythmia & Electrophysiology Review ◽

10.15420/aer.2018.80.2 ◽

2019 ◽

Vol 8 (1) ◽

pp. 65-69 ◽

Cited By ~ 3

Author(s):

Josef Kautzner ◽

Petr Peichl

Keyword(s):

Catheter Ablation ◽

Papillary Muscle ◽

Ventricular Arrhythmias ◽

Radiofrequency Catheter Ablation ◽

Intracardiac Echocardiography ◽

Imaging Method ◽

Papillary Muscles ◽

Catheter Tip ◽

Activation Mapping

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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