Related Experiment Video
Updated: Mar 11, 2026
Real-Time Cardiac Mapping with a Noninvasive Imageless Electrocardiographic Imaging System
Published on: April 11, 2025
Ventricular arrhythmias associated with left ventricular noncompaction: Electrophysiologic characteristics, mapping,
Daniele Muser1, Jackson J Liang1, Walter Rt Witschey2
1Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Insights
Catheter ablation effectively treats ventricular arrhythmias (VAs) in left ventricular noncompaction (LVNC) patients, with most experiencing long-term VA control and some showing improved heart function. This procedure is safe and beneficial for managing VAs in LVNC.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Left ventricular noncompaction (LVNC) is a primary cardiomyopathy associated with recurrent ventricular arrhythmias (VAs).
- Limited data exists on the efficacy of catheter ablation for VAs in LVNC patients.
Purpose of the Study:
- To describe the electrophysiologic characteristics of VAs in LVNC.
- To evaluate the outcomes of catheter ablation for VAs in LVNC.
Main Methods:
- Nine patients with LVNC and VAs (VT or frequent PVCs) despite antiarrhythmic drugs were studied.
- Ablation sites were identified using entrainment, activation mapping, and pace-mapping techniques.
- Electrophysiologic substrate was correlated with imaging findings.
Main Results:
- Most patients (89%) had left ventricular systolic dysfunction.
- VT substrate involved mid-apical LV segments, while PVCs originated from papillary muscles and/or basal septal regions.
- After a median follow-up of 4 years and 1.8 procedures, only 11% experienced VA recurrence; 50% showed improved LV function, with no deaths or transplants.
Conclusions:
- VA substrate in LVNC with VT is typically mid-apical, whereas focal PVCs originate from basal-septal regions/papillary muscles.
- Catheter ablation is a safe and effective treatment for long-term VA control in LVNC patients.
- The procedure can lead to significant improvement in left ventricular function.
Background:
Left ventricular noncompaction (LVNC) is a primary cardiomyopathy that can present with recurrent ventricular arrhythmias (VAs). Data on the benefit of catheter ablation of VAs in LVNC are lacking.
Objective:
The purpose of this study was to describe the electrophysiologic features and outcomes of catheter ablation of VAs in LVNC.
Methods:
The cohort consisted of 9 patients (age 42 ± 15 years) with diagnosis of LVNC based on established criteria and VA (ventricular tachycardia [VT] in 3 and frequent premature ventricular contractions (PVCs) in 6) despite treatment with a mean of 2 ± 1 antiarrhythmic drugs. Ablation sites were identified using a combination of entrainment, activation, late/fractionated potential ablation, and pace-mapping.
Results:
A total of 8 patients (89%) had left ventricular (LV) systolic dysfunction (mean ejection fraction 40% ± 13%). Patients who presented with VT had evidence of abnormal electroanatomic substrate involving the mid- to apical segments of the LV, which matched the noncompacted myocardial segments identified by preprocedural magnetic resonance imaging or echocardiography. In patients presenting with frequent PVCs, the site of origin was identified at the papillary muscles (50%) and/or basal septal regions (67%). After median follow-up of 4 years (range 1-11) and a mean of 1.8 ± 1.1 procedures, VAs recurred in 1 patient (11%). Significant improvement in LV function occurred in 4 of 8 cases (50%). No patients died or underwent heart transplantation.
Conclusion:
The VA substrate in patients with LVNC and VT typically involves the mid-apical LV segments, whereas focal PVCs often arise from LV basal-septal regions and/or papillary muscles. Catheter ablation is safe and effective in achieving good VA control over long-term follow-up in most patients.
More Related Videos
06:57Ablation of Ischemic Ventricular Tachycardia Using a Multipolar Catheter and 3-dimensional Mapping System for High-density Electro-anatomical Reconstruction
Published on: January 31, 2019
09:13Remote Magnetic Navigation for Accurate, Real-time Catheter Positioning and Ablation in Cardiac Electrophysiology Procedures
Published on: April 21, 2013
Related Concept Videos
01:25ECG Interpretation of Arrhythmias II: Atrial, Junctional and Ventricular Arrhythmias
01:28Mechanism of Cardiac Arrhythmias
01:29Disturbances in Heart Rhythm
Arrhythmias are categorized by their speed, rhythm, and origin. A slow heart...
01:19Electrophysiology of Normal Cardiac Rhythm
01:18Dysrhythmias IV: Characteristics of Bradyarrhythmias
01:30Cardiac Action Potential
The cardiac action potential process involves a series of phases characterized by the movement of ions across the cardiac cell membranes, leading to the depolarization and repolarization of the cardiac myocytes.
Ionic Basis of Cardiac Action Potentials