Key result
High-amplitude discrete potentials before QRS and a slow downstroke of the initial Q wave on the unipolar electrogram at ablation sites were significantly associated with favorable ablation outcomes.
Observational (n=12)
No
Absolute Event Rate: 85.7% vs 0%
p-value: p=<0.01
High-amplitude discrete potentials and a slow downstroke of the initial Q wave on unipolar electrograms are associated with successful radiofrequency catheter ablation of idiopathic ventricular arrhythmias originating from the left ventricular papillary muscle.
May aid site selection during papillary muscle VA ablation; hypothesis-generating for prospective validation of electrogram-guided strategy.
BACKGROUND AND OBJECTIVES: The electrophysiological properties associated with favorable outcome of radiofrequency catheter ablation (RFCA) for idiopathic ventricular arrhythmia (VA) originating from the papillary muscle (PM) remain unclear. The purpose of this study was to investigate the relationships of electrophysiological characteristics and predictors with the outcome of RFCA in patients with VAs originating from PM in the left ventricle (LV). SUBJECTS AND METHODS: Twelve (4.2%) of 284 consecutive patients with idiopathic VAs originating from LV PM were assessed. The electrophysiological data were compared between the patients in the successful group and patients in the recurrence group after RFCA. RESULTS: In 12 patients with PM VAs, non-sustained ventricular tachycardias (VTs, n=6), sustained VTs (n=4) and premature ventricular complexes (n=2) were identified as the presenting arrhythmias. Seven of eight patients showing high-amplitude discrete potentials at the ablation site had a successful outcome (85.7%), while the remaining four patients who showed low-amplitude fractionated potentials at the ablation site experienced VA recurrence. The mean duration from onset to peak downstroke (Δt) on the unipolar electrogram was significantly longer in the successful group than in the recurrence group (58±8 ms vs. 37±9 ms, p=0.04). A slow downstroke >50 ms of the initial Q wave on the unipolar electrogram at ablation sites was also significantly associated with successful outcome (85.7% vs. 25.0%, p=0.03). CONCLUSION: In PM VAs, the high-amplitude discrete potentials before QRS and slow downstroke of the initial Q wave on the unipolar electrogram at ablation sites were related to favorable outcome after RFCA.
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Ban et al. (2013) conducted an observational in Idiopathic ventricular arrhythmia originating from the papillary muscle in the left ventricle (n=12). High-amplitude discrete potentials and slow downstroke of initial Q wave at ablation site vs. Absence of these electrophysiological characteristics was evaluated on Presence of high-amplitude discrete potentials >1.0 mV at the ablation site in successful vs recurrence groups (p=<0.01). High-amplitude discrete potentials before QRS and a slow downstroke of the initial Q wave on the unipolar electrogram at ablation sites were significantly associated with favorable ablation outcomes.
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