Heterogeneous gadolinium uptake on MRI was observed significantly more frequently in arrhythmogenic papillary muscles than in those not involved in ventricular arrhythmias (p=0.01).
Case-Control (n=18)
Does heterogeneous gadolinium uptake on DEMRI predict arrhythmogenic papillary muscles, and is radiofrequency ablation effective for post-infarction ventricular arrhythmias originating from papillary muscles?
Heterogeneous gadolinium uptake on MRI can predict arrhythmogenic papillary muscles in post-infarction patients, and radiofrequency ablation of these arrhythmias is highly successful without worsening mitral regurgitation.
p-value: p=0.01
OBJECTIVES: The aim of this study was to define the role of papillary muscles (PAPs) in post-infarction ventricular arrhythmias. BACKGROUND: Papillary muscles have been implicated in arrhythmogenesis; however, their role in post-infarction ventricular arrhythmias has not been well-defined. METHODS: In a series of 9 patients (age 65 +/- 9 years, ejection fraction 0.36 +/- 0.1) with post-infarction ventricular arrhythmias, electroanatomic mapping in conjunction with intracardiac echocardiography demonstrated that 1 of the PAPs was involved in the arrhythmia. Magnetic resonance imaging with delayed enhancement (DEMRI) was performed in all patients without contraindications. A consecutive series of 9 patients (age 64 +/- 8 years, ejection fraction 0.32 +/- 0.14) with ventricular arrhythmias that did not originate from the PAP served as a control group and also underwent DEMRI. RESULTS: Heterogeneous uptake of gadolinium during magnetic resonance imaging was observed more frequently in arrhythmogenic PAPs than in PAPs that were not involved in ventricular arrhythmias (p = 0.01). The PAPs in the control patients did not take up contrast or show homogeneous contrast uptake. Radiofrequency ablation eliminated all arrhythmias originating from PAPs. Echocardiography after the ablation showed no new or worsened mitral regurgitation. CONCLUSIONS: Papillary muscles that lie within an infarct zone might give rise to ventricular arrhythmias. Heterogeneous uptake of gadolinium in magnetic resonance images might be predictive of arrhythmogenic PAPs. Radiofrequency catheter ablation of ventricular tachycardia and ventricular ectopy arising in a PAP has a high success rate.
Bogun et al. (Wed,) conducted a case-control in Post-infarction ventricular arrhythmias (n=18). Magnetic resonance imaging with delayed enhancement (DEMRI) and radiofrequency ablation vs. Patients with ventricular arrhythmias not originating from papillary muscles was evaluated on Heterogeneous uptake of gadolinium during magnetic resonance imaging (p=0.01). Heterogeneous gadolinium uptake on MRI was observed significantly more frequently in arrhythmogenic papillary muscles than in those not involved in ventricular arrhythmias (p=0.01).