Percutaneous cryoablation for papillary muscle ventricular arrhythmias after failed radiofrequency catheter ablation.
Publication/Presentation Date
12-1-2018
Abstract
BACKGROUND: Catheter ablation of ventricular arrhythmias (VA) from the papillary muscles (PM) is challenging due to limited catheter stability and contact on the PMs with their anatomic complexity and mobility.
OBJECTIVE: This study aimed to evaluate the effectiveness of cryoablation as an adjunctive therapy for PM VAs when radiofrequency (RF) ablation has failed.
METHODS: We evaluated a retrospective series of patients who underwent cryoablation for PM VAs when RF ablation had failed. The decision to switch to cryoablation was at the operator's discretion when intracardiac echocardiography (ICE) suggested that cryoablation might be more effective in achieving catheter stability and energy delivery.
RESULTS: Sixteen patients underwent cryoablation of PM VAs between 2014 and 2016 after RF ablation was unsuccessful. VAs originated from the anterolateral left ventricle (LV) PM (six patients), posterolateral LV PM (six patients), and right ventricle PM (four patients). VAs were predominantly frequent premature ventricular complexes (PVCs); however, patients with sustained ventricular tachycardia and PVC-triggered VF were also represented. Fifteen of the 16 patients were treated with cryoablation; in one patient, a procedural complication with retrograde aortic access precluded treatment. In all patients treated with cryoablation, contact and stability was confirmed with ICE to be superior to the RF catheter, and there was acute and long-term elimination of VAs.
CONCLUSION: Cryoablation is a useful adjunctive therapy in ablation of PM VAs, providing excellent procedural outcomes even when RF ablation has failed. Cryoablation catheters are less maneuverable than RF ablation catheters and care is required to avoid complications.
Volume
29
Issue
12
First Page
1654
Last Page
1663
ISSN
1540-8167
Published In/Presented At
Gordon, J. P., Liang, J. J., Pathak, R. K., Zado, E. S., Garcia, F. C., Hutchinson, M. D., Santangeli, P., Schaller, R. D., Frankel, D. S., Marchlinski, F. E., & Supple, G. E. (2018). Percutaneous cryoablation for papillary muscle ventricular arrhythmias after failed radiofrequency catheter ablation. Journal of cardiovascular electrophysiology, 29(12), 1654–1663. https://doi.org/10.1111/jce.13716
Disciplines
Medicine and Health Sciences
PubMedID
30106213
Department(s)
Department of Medicine, Cardiology Division
Document Type
Article