Combination of Intracardiac Echocardiography and Contact Force Sensing for Left Ventricular Papillary Muscle Arrhythmias

Objectives: The catheter ablation of ventricular arrhythmias (VAs) arising from the left ventricular (LV) papillary muscles (PMs) is challenging. This study sought to address whether the combination of intracardiac echocardiography (ICE) and contact force sensing (CFS) can improve the acute and long-term ablation outcomes of left ventricular papillary muscle arrhythmias. Methods and Results: From May 2015 to August 2022, a total of thirty-three patients underwent catheter ablation for LV PM arrhythmias: VAs were located in anterolateral PMs in 11 and posteromedial PMs in 22. A combination of intracardiac echocardiography (ICE) and contact force sensing (CFS) was used in 21 of the 33 procedures. A mean of 6.93 +/- 4.91 for lesions was used per patient, comparable between the CFS/ICE and no ICE/CFS (4.90 +/- 2.23 vs. 10.17 +/- 5.89; p = 0.011). The mean CF achieved in the ICE/CFS group was 7.52 +/- 3.31 g. Less X-ray time was used in the combination group (CFS/ICE: 165.67 +/- 47.80 S vs. no ICE/CFS: 365.00 +/- 183.73 S; p < 0.001). An acute success rate of 100% was achieved for the ICE/CFS group (n = 22) and 66.67% for the no ICE/CFS group (n = 8). VA recurrence at the 11.21 +/- 7.21-month follow-up was 14.2% for the ICE/CFS group and 50% for the no ICE/CFS group (p = 0.04). No severe complications occurred in all patients. Conclusions: The combination of intracardiac echocardiography (ICE) and contact force sensing (CFS) could provide precise geometries of cardiac endocavitary structures and accurate contact information for the catheter during ablation, which improved acute and long-term ablation outcomes. The routine adoption of this strategy should be considered to improve the outcomes of LV PM VA ablation.

Automated summary

Objective: This study aimed to investigate the clinical features, radiological and pathological characteristics, prognostic factors, and outcomes of patients with pulmonary arterial hypertension (PAH) complicated with coronary heart disease, heart failure, or arrhythmia. The clinical data, cardiac function, radiological findings, and pathological examination results of 15 patients with PAH and dual-source atrial fibrillation treated between January 2014 and January 2019 were analyzed, and the relevant factors were evaluated. Results: The data showed that the degree of coronary heart disease significantly influenced the clinical manifestations of patients with PAH, with a higher incidence of severe pulmonary artery lesions, allergic bronchopulmonary aspergillosis (ABPA), and persistent pulmonary hypertension (PCH). Further analysis revealed various clinical features of ABPA, which could be well detected through clinical examination and radiological imaging. Follow-up findings indicated a poor prognosis in patients with PAH with a significant correlation with the severity of coronary heart disease, and worse prognosis in patients with ABPA when coronary heart disease was more severe.