Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
Cardiology Department, Division of Clinical Electrophysiology Postgraduate Medical School, Grochowski Hospital, Warsaw, Poland.
J Cardiovasc Electrophysiol. 2018 Jan;29(1):64-70. doi: 10.1111/jce.13338. Epub 2017 Sep 26.
Frequent ventricular premature complexes (VPCs) may cause symptoms and/or lead to deterioration of LV systolic function. Although frequent VPCs may be abolished by catheter ablation, it may be challenging in case of their origin from the LV papillary muscles (PMs). Our collaborative study aimed to analyze in detail the site of origin and the outcome of ablation.
Consecutive 34 patients (males: 68%; aged 62 ± 12 years; LV ejection fraction: 50 ± 9%) undergoing catheter ablation of VPCs originating from PMs were included. All procedures were guided by intracardiac echocardiography.
The size and shape of PMs were highly variable. The length of anterolateral and posteromedial PM was 23 ± 4 mm and 28 ± 7 mm, respectively. In about one-third of patients, the PM was formed by two distinctly separate heads. The ectopic foci were located on anterolateral, posteromedial or both PM in 35%, 56% and 9% of cases, respectively. Their location was found within the distal, mid, or proximal (basal) third of PM in the 67%, 19%, and 14%, respectively. A total of 86% of PM foci were acutely abolished and long-term success was achieved in 65% of patients. Absence of VPCs of other morphologies and a high burden of ectopic activity before ablation were associated with favorable clinical outcome.
VPCs originate predominantly from the distal portion of the PM. This knowledge may facilitate the mapping in patients with infrequent ectopic beats. Intracardiac echocardiography is of crucial importance for navigation of the ablation catheter and for assessment of its stability at PM target sites.
频发室性早搏（VPCs）可能导致症状和/或导致左心室收缩功能恶化。尽管频发 VPCs 可能通过导管消融消除，但如果起源于左心室乳头肌（PMs），则可能具有挑战性。我们的合作研究旨在详细分析起源部位和消融结果。
连续纳入 34 例（男性：68%；年龄 62 ± 12 岁；左心室射血分数：50 ± 9%）起源于 PM 的 VPC 导管消融患者。所有程序均由心内超声心动图引导。
PM 的大小和形状差异很大。前外侧和后内侧 PM 的长度分别为 23 ± 4mm 和 28 ± 7mm。在大约三分之一的患者中，PM 由两个明显分开的头部组成。异位病灶分别位于前外侧、后内侧或 PM 的两者均位于 35%、56%和 9%的病例中。它们的位置位于 PM 的远端、中部或近端（基底）的三分之一内，分别占 67%、19%和 14%。共有 86%的 PM 病灶被急性消除，65%的患者获得长期成功。消融前无其他形态 VPCs 和异位活动高负荷与良好的临床结果相关。
VPCs 主要起源于 PM 的远端。这一知识可能有助于在异位搏动频率较低的患者中进行映射。心内超声心动图对于消融导管的导航和评估其在 PM 靶位的稳定性至关重要。
