Radiofrequency ablation of ventricular arrhythmias originating from ventricular papillary muscle

Liu Jianguo; Zhang Yanling; Cui Junyu

doi:10.3969/j.issn.1674-4055.2017.09.10

Abstract：Objective To guide radiofrequency ablation of ventricular arrhythmias originating from ventricular papillary muscle by analysis of surface electrocardiogram and features of activation mapping. Methods From December of 2015 to March of 2016, six ventricular arrhythmias patients originating from ventricular papillary muscle received radiofrequency ablation. 12 leads electrocardiogram and dynamic electrocardiogram were accomplished before the procedure. Activation mapping was implemented with CARTO3 during the procedure. At the corresponding period, twelve ventricular arrhythmias patients originating from right ventricular outflow tract septum were chosen as controls according to age and medical history. Results Six ventricular arrhythmias patients originating from ventricular papillary muscle were ablated instantly. However, ventricular arrhythmias reappeared in one patient at the 2nd day after the procedure. Compared with ventricular arrhythmias from non-papillary muscle, QRS duration of surface electrocardiogram elongated significantly, and notches appeared in the descending branch of QRS. P potentials or papillary muscle potentials at low amplitude were found in four patients during activation mapping. Four non-Smartouch and two Smartouch catheters were used during the ablation. Catheter manipulation and activation mapping were more difficult in ventricular arrhythmias patients originating from ventricular papillary muscle than in ventricular arrhythmias patients from non-papillary muscle, and procedure time elongated apparently. However, none of the six patients employed intracardiac echocardiography. Conclusion QRS duration of surface electrocardiogram in ventricular arrhythmias patients originating from ventricular papillary muscle elongated significantly, accompanied with descending branch notches. Although catheter manipulation was difficult during the procedure, intracardiac echocardiography wasn't necessary after a grasp of mapping skill, and successful rate of ablation was relatively high.