Catheter ablation of premature ventricular complexes originating from papillary muscles using dual-energy lattice-tip focal catheter
F Schlosser, P Peichl, D Wichterle, P Stojadinovic, E Borisincova, P Stiavnicky, J Haskova, J Marek, R Cihak, J KautznerAbstract
Background
Catheter ablation of premature ventricular complexes (PVCs) arising from papillary muscles is particularly challenging, mainly due to its complex anatomy and excessive mobility with unsatisfactory short- and long-term results.
Purpose
To investigate the efficacy and safety of papillary muscle PVCs ablation using a novel large footprint catheter that toggles between radiofrequency (RF) and pulsed field (PF) energy.
Methods
Patients with frequent ventricular ectopy originating either from the left or right ventricular papillary muscles were assigned to catheter ablation using a dual-energy lattice-tip focal ablation catheter. After activation mapping of the ectopy guided by electro-anatomical mapping and intracardiac echocardiography, patients were induced into deep anesthesia and then ablated using either PF energy or a combination of PF and RF. Levels of high sensitivity troponin T (hsTnT) were assessed before and the next day (18-24 hours) after ablation. Follow-up with an ambulatory ECG monitoring was scheduled in 3 months after the procedure.
Results
The study population comprised 10 patients (aged 55±6 years, 3 women). Baseline and periprocedural characteristics are listed in Figure. In seven patients PVCs originated from the left ventricle, the rest from the right ventricular papillary muscles. Only PF ablation (5.5 seconds per application) was used in 6 patients (9,8±4,6 applications). Four patients were ablated using a combination of PF (11,5±4,1 applications) and RF (34±84 seconds) energy. Acute success was accomplished in all patients. At follow-up of 99±25 days, 9 patients (90 %) had a decrease of ectopy to less than 2%. One female patient with mitral valve prolapse and PVCs originating from the posteromedial papillary muscle had a recurrence of ectopy. There were no periprocedural nor short-term complications.
Conclusion
Catheter ablation of PVCs originating from papillary muscles using a dual-energy lattice-tip focal ablation catheter seems to be safe and feasible with excellent acute and short-term results. More data are needed to confirm this observation.Figure