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 perpendicular to 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. (J Am Coll Cardiol EP 2022;8:1475-1483) (c) 2022 by the American College of Cardiology Foundation.

Automated summary

Lesions delivered during catheter ablation of ventricular arrhythmias originating from left ventricular papillary muscles can be safely performed without adverse impact on mitral valve function, as demonstrated by this study.