Author + information
- Received February 26, 2020
- Revision received June 22, 2020
- Accepted June 23, 2020
- Published online September 16, 2020.
- Aung N. Lin, MDa,
- Yasuhiro Shirai, MDa,
- Jackson J. Liang, DOa,b,
- Shiquan Chen, MDa,
- Arshneel Kochar, MDa,
- Matthew C. Hyman, MD, PhDa,
- Pasquale Santangeli, MD, PhDa,
- Robert D. Schaller, DOa,
- David S. Frankel, MDa,
- Jeffrey S. Arkles, MDa,
- Ramanan Kumareswaran, MDa,
- Fermin C. Garcia, MDa,
- Michael P. Riley, MD, PhDa,
- Saman Nazarian, MD, PhDa,
- David Lin, MDa,
- Erica C. Zado, PAa,
- David J. Callans, MDa,
- Francis E. Marchlinski, MDa,
- Gregory E. Supple, MDa and
- Sanjay Dixit, MDa,∗ ()
- aElectrophysiology Section, Cardiology Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
- bElectrophysiology Section, Cardiology Division, University of Michigan, Ann Arbor, Michigan
- ↵∗Address for correspondence:
Dr. Sanjay Dixit, Electrophysiology Section, Cardiology Division, Hospital of the University of Pennsylvania, 9 Founders Pavilion, 3400 Spruce Street, Philadelphia, Pennsylvania 19104.
Objectives This study sought to address whether technological innovations such as contact force sensing (CFS) can improve acute and long-term ablation outcomes of left ventricular papillary muscle (LV PAP) ventricular arrhythmias (VAs).
Background Catheter ablation of LV PAP VAs has been less efficacious than another focal VAs. It remains unclear whether technological innovations such as CFS can improve acute and long-term ablation outcomes of LV PAP VA.
Methods From January 2015 to December 2019, a total of 137 patients underwent LV PAP VA ablation. VA site of origin (SOO) was identified using activation and pace-mapping guided by intracardiac echocardiography. Radiofrequency energy (20 to 50 W for 60 to 90 s) was delivered by irrigated catheter with or without CFS. We defined acute success as complete suppression of targeted VA ≥30 min post ablation and clinical success as ≥80% VA burden reduction at outpatient follow-up.
Results VA manifested as premature ventricular complexes in 98 (71%), nonsustained ventricular tachycardia in 18 (13%), sustained ventricular tachycardia in 12 (9%) and premature ventricular complexes induced ventricular fibrillation in 9 (7%). VA SOO was anterolateral PAP in 51 (37%), posteromedial PAP in 73 (53%), and both PAPs in 13 (10%). VAs were targeted using CFS in 97 (71%) and non-CFS in 40 (29%). After a single procedure, acute success was achieved in 130 (95%) and clinical success was achieved in 112 (82%); neither was impacted by VA SOO and/or CFS. Complications occurred in 5 patients (3.6%).
Conclusion Independent of CFS technology, intracardiac echocardiography-guided catheter ablation is highly efficacious and may be considered as first-line therapy in the management of LV PAP VA.
This work was supported by the JV and JV Fund in Electrophysiology. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received February 26, 2020.
- Revision received June 22, 2020.
- Accepted June 23, 2020.
- 2020 American College of Cardiology Foundation
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