Application of pressure monitoring catheter to ablate left ventricular papillary muscle ventricular arrhythmia by three-dimensional intracardiac ultrasound guided catheterization
Zhang Tao
Ren Xuejun
Han Zhihong
Zhao Hua
Wang Ye
Li Xuebin
Wang Yunlong.
Abstract：Objective To introduce catheter ablation of ventricular arrhythmias (VAs) originating from left ventricular papillary muscle guided by three-dimensional intracardiac echocardiography (ICE). Methods From June 2017 to April 2018, 10 patients in the Department of Cardiology of Beijing Anzhen Hospital who underwent CartoSound-guided radiofrequency ablation for the treatment of left ventricular papillary muscle VAs were performed with pressure monitoring catheters and radiofrequency ablation. The QRS complex characteristics of the 12-lead ECG were analyzed. Results Among 10 patients, QRS wave time were 149.0±17.8 ms and the target sites were located at the left anterior papillary muscle (APM) in 4 patients and the left posterior papillary muscle(PPM) in 6 patients.VAs arising from the APM typically demonstrate a right bundle branch block (RBBB) morphology, right axis, negative in aVL, positive in III. VAs from the PPM show a RBBB morphology, left superior axis positive in aVL, negative in III. Except one cases originating from the left PPM, the other 9 patients were successfully ablated and followed up for 6 months.One patient originating from the left PPM had recurrence during follow-up. The earliest bipolar electrograms of the targets preceded the onset of the QRS complex during VAs by 25.8±3.8 ms, and the targets of 9 patients presented sharp potential before QRS during VAs. The average number of discharges in patients with immediate ablation was (2.4±1.3) times. Conclusions ECG characteristics of VAs originating from left APM muscles is different from which originating from left PPM.Catheter ablation of VAs originating from left ventricular papillary muscle guided by three-dimensional ICE was feasible and effective with a high success rate and low recurrence rate.
Keywords：Ventricular arrhythmiaElectrocardiogramCatheter ablationPapillary muscleIntracardiac echocardiography
Publication Date：2019-01-01
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：4( 328-331 )