Electrophysiological Characteristics Related to Outcome after Catheter Ablation of Idiopathic Ventricular Arrhythmia Originating from the Papillary Muscle in the Left Ventricle

다국어 초록 (Multilingual Abstract)

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.

참고문헌 (Reference)

1 Doppalapudi H, "Ventricular tachycardia originating from the posterior papillary musclein the left ventricle: a distinct clinical syndrome" 1 : 23-29, 2008

2 Good E, "Ventricular arrhythmiasoriginating from a papillary muscle in patients without prior infarction:a comparison with fascicular arrhythmias" 5 : 1530-1537, 2008

3 Crawford T, "Ventricular arrhythmias originatingfrom papillary muscles in the right ventricle" 7 : 725-730, 2010

4 Aiba T, "The role of Purkinje and pre-Purkinjepotentials in the reentrant circuit of verapamil-sensitive idiopathic LVtachycardia" 24 : 333-344, 2001

5 Yamada T, "Successfulcatheter ablation of a ventricular tachycardia storm originatingfrom the left ventricular posterior papillary muscle involved witha remote myocardial infarction" 24 : 143-145, 2009

6 Liu XK, "Successful management ofrecurrent ventricular tachycardia by electrical isolation of anterolateralpapillary muscle" 5 : 479-482, 2008

7 Pak HN, "Role of the posterior papillary muscleand purkinje potentials in the mechanism of ventricular fibrillation inopen chest dogs and Swine: effects of catheter ablation" 17 : 777-783, 2006

8 Kim YH, "Role of papillary muscle in the generationand maintenance of reentry during ventricular tachycardia and fibrillationin isolated swine right ventricle" 100 : 1450-1459, 1999

9 Yokokawa M, "Predictors of successful catheterablation of ventricular arrhythmias arising from the papillarymuscles" 7 : 1654-1659, 2010

10 Bogun F, "Post-infarction ventricular arrhythmiasoriginating in papillary muscles" 51 : 1794-1802, 2008

11 Chen PS, "Papillary muscle hypothesis ofidiopathic left ventricular tachycardia" 37 : 1475-1476, 2001

12 Zipes DP, "Mechanisms of clinical arrhythmias" 14 : 902-912, 2003

13 Yamada T, "Idiopathic ventricular arrhythmiasoriginating from the papillary muscles in the left ventricle:prevalence, electrocardiographic and electrophysiological characteristics,and results of the radiofrequency catheter ablation" 21 : 62-69, 2010

14 Yamada T, "Idiopathic focal ventricular arrhythmiasoriginating from the anterior papillary muscle in the leftventricle" 20 : 866-872, 2009

15 Yamada T, "Electrocardiographic andelectrophysiological characteristics in idiopathic ventricular arrhythmiasoriginating from the papillary muscles in the left ventricle: relevancefor catheter ablation" 3 : 324-331, 2010

16 Maruyama M, "Demonstration of the reentrantcircuit of verapamil-sensitive idiopathic left ventricular tachycardia:direct evidence for macroreentry as the underlying mechanism" 12 : 968-972, 2001

17 Nogami A, "Demonstration of diastolic and presystolicPurkinje potentials as critical potentials in a macroreentry circuitof verapamil-sensitive idiopathic left ventricular tachycardia" 36 : 811-823, 2000