Impact of Left Ventricular Papillary Muscle Ventricular Arrhythmia Ablation on Mitral Valve Function.

Background: Although efficacious, catheter ablation (CA) of ventricular arrhythmias (VAs) originating from left ventricular (LV) papillary muscles (PAPs) has the potential to affect mitral valve (MV) function.
Objectives: The aim of this study was to determine whether lesions delivered during CA of VAs from LV PAPs affected MV function.
Methods: Consecutive patients undergoing CA of LV PAP VAs from January 2015 to December 2020 in whom both preprocedural and postprocedural transthoracic echocardiography was performed were included. Radiofrequency ablation was performed with an irrigated-tip catheter with or without contact force sensing and intracardiac echocardiographic guidance. The PAPs were delineated into segments: tip, body, and base. Pre- and post-CA transthoracic echocardiograms were reviewed to assess MV regurgitation, which was graded 0 (none), 1 (mild), 2 (moderate), or 3 (severe). A change of ≥2 grades from baseline was considered significant.
Results: A total of 103 patients (mean age 63 ± 15 years, 78% men) were included. VAs were ablated from the anterolateral PAP in 35% (n = 36), posteromedial PAP in 55% (n = 57), and both PAPs in 10% (n = 10). Lesion distribution was as follows: PAP tip in 52 (50%), PAP base in 34 (33%), PAP body in 13 (13%), and entire PAP in 4 (4%). The mean number of lesions delivered was 16 ± 13 (median 14). Of 103 patients, 102 (99%) showed no change in MV function.
Conclusions: Using intracardiac echocardiographic guidance, lesions can be safely delivered on various aspects of this structure without adverse impact on MV function.
Competing Interests: Funding Support and Author Disclosures This work was supported by the Richard T and Angela Clark Innovation Fund in Cardiovascular Medicine. Dr Lin has received a speaker honorarium from Abbott. Dr Frankel is a scientific advisory board member for Biosense Webster. Dr Santangeli has received a research grant from Biosense Webster; and is an advisory board member for Biosense Webster and Abbott. Dr Nazarian has received a research grant from Biosense Webster. Dr Hyman has given educational lectures for Biosense Webster. Dr Epstein is an advisory board and events committee member for Abbott; and is an events committee member for Boston Scientific and Medtronic. Dr Callans is an advisory board member for Abbott and Biosense Webster; and has received honoraria for lectures from Biosense Webster. Dr Marchlinski has received a lecture honorarium from and is a scientific advisory board member for Abbott; and is a scientific advisory board member for and has received a lecture honorarium and research support from Biosense Wesbet. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
(Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)