Multipolar mapping for catheter ablation of premature ventricular
complexes originating from papillary muscles in the structurally normal
heart
Abstract
Introduction: Previous studies on radiofrequency catheter ablation of
premature ventricular complexes (PVCs) arising from the left ventricle
(LV) papillary muscles (PM) show a modest procedural success rate with
higher recurrence rate. This study explored the utility of using a
multipolar catheter for ablating the PM PVCs. Methods and Results:
Endocardial mapping was performed via retrograde aortic approach using a
steerable duodecapolar catheter in 6 patients and conventional
point-by-point catheter in 5 patients, respectively. Compared with
patients in point-by-point catheter group, duodecapolar catheter mapping
demonstrated higher efficiency with an average procedure time and
fluoroscopy time. The values of earliest activation time during mapping
using duodecapolar catheter were significantly greater (32.3 ± 3.9 ms
vs. 25.4 ± 2.8 ms). The mean number of ablation applications points in
the duodecapolar catheter group was 6.8 ± 1.9 with an average overall
ablation duration of 6.1 ± 3.0 minutes, which was significantly less
compared to the point-by-point catheter group. There were no
complications in duodecapolar catheter group whereas one cardiac
tamponade occurred in the point-by-point catheter group. All 6 patients
(100%) in the duodecapolar catheter group demonstrated acute successful
ablation whereas only 3 of the 5 patients (60%) with point-by-point
catheter ablation succeeded, and the intermediate success rate remained
the same after an average follow-up of 9.7 ± 3.2 months. Conclusions:
Mapping and ablation of PM PVCs using a duodecapolar catheter
facilitated identification of earliest activation potentials and pace
mapping, and demonstrated a high success rate during follow-up when
compared to conventional mapping techniques.