Catheter Ablation of Papillary Muscle Arrhythmias: Implications of Mitral Valve Prolapse and Systolic Dysfunction

Lee, Adam, Hamilton Craig, Christian, Denman, Russell and Haqqani, Haris M (2018) Catheter Ablation of Papillary Muscle Arrhythmias: Implications of Mitral Valve Prolapse and Systolic Dysfunction. Pacing and clinical electrophysiology : PACE, . doi:10.1111/pace.13363


Author Lee, Adam
Hamilton Craig, Christian
Denman, Russell
Haqqani, Haris M
Title Catheter Ablation of Papillary Muscle Arrhythmias: Implications of Mitral Valve Prolapse and Systolic Dysfunction
Journal name Pacing and clinical electrophysiology : PACE   Check publisher's open access policy
ISSN 1540-8159
Publication date 2018-05-06
Sub-type Article (original research)
DOI 10.1111/pace.13363
Open Access Status Not yet assessed
Abstract The left ventricular papillary muscles are important components of the mitral valve apparatus. Catheter ablation of ventricular arrhythmias from these sites is challenging. We aim to describe the association between LV papillary muscle ventricular arrhythmias (VAs) and mitral valve prolapse (MVP), and to determine the outcomes of ablation in these patients with a focus on those with MVP and cardiomyopathy.

152 patients underwent 170 consecutive procedures for ablation of focal VAs. Mitral valve prolapse and cardiomyopathy were diagnosed by echocardiography. Outcomes following ablation were assessed in 3 groups: i) LV papillary muscle VAs vs other sites ii) LV papillary muscle VAs by the presence of MVP iii) LV papillary muscle VAs in the setting of cardiomyopathy.

9 of 23 (39%) patients undergoing ablation of LV papillary muscle VAs had MVP compared to none of 129 (0%) patients at other sites (p < 0.001). In the former group, acute procedural success was achieved in 60% and 80% of those with and without MVP respectively (p = 0.28). Medium term outcomes were comparable (p = 0.75). In patients with cardiomyopathy, the median LV ejection fraction improved from 40% to 54% following ablation (p = 0.007).

Although MVP is strongly associated with LV papillary muscle VAs, MVP does not adversely affect the acute or medium-term outcomes of ablation. Systolic function can improve following ablation in patients with ectopy-mediated cardiomyopathy due to papillary muscle VAs. This article is protected by copyright. All rights reserved.
Keyword VT
ablation
electrophysiology - clinical
mitral valve prolapse
papillary muscle
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: Pubmed Import
 
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Created: Wed, 09 May 2018, 10:03:01 EST