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

Background Catheter ablation of ventricular arrhythmias (VAs) arising from the left ventricle`s (LV) papillary muscles (PM) is challenging. In this study we present results of catheter ablation using multiple energy sources and image‐based approaches. Methods Fifty‐three patients (49 ± 17 years old; 34% females; median LV ejection fraction 53 ± 11%) underwent catheter cryoablation or radiofrequency (RF) ablation with non‐contact force sensing (Non‐CFS) catheters and cardiac computed tomography integration (CTII) into the electroanatomical mapping system or contact force sensing RF (CFS RF) ablation catheters and intracardiac echo‐facilitated 3D electroanatomical mapping. Ventricular arrhythmias foci were mapped at either the anterolateral (ALPM) or posteromedial papillary muscles (PMPM). Ablation was performed using an 8‐mm cryoablation catheter (CRYO); a Non‐CFS 4‐mm open‐irrigated RF catheter; or a CFS RF 3.5‐mm open‐irrigated tip catheter, via transmitral or transaortic approach. Results Acute success rate was 83% for Non‐CFS RF/CTII; 100% for CRYO/CTII (n = 16) and CFS RF/ICE3D (n = 14) ( P = 0.03). Catheter stability was achieved in all patients treated with Cryo/CTII. VA recurrence at 12 months follow‐up was 48% (n = 11) for Non‐CFS RF/CTII; 19% (n = 3) for CRYO/CTII; and 7% (n = 1) for CFS RF/ICE3D ( P = 0.02). Conclusions Non‐CFS/CTII was associated with an increased risk of recurrence of the clinical arrhythmia. Ablation with either CFS RF/ICE3D or CRYO/CTII showed high acute success rates and low recurrence rates during follow‐up. Cryoablation provided stable contact and was less arrhythmogenic.

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