Related Experiment Video
Updated: Aug 16, 2025
A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
Published on: October 16, 2021
Impact of Left Ventricular Papillary Muscle Ventricular Arrhythmia Ablation on Mitral Valve Function
Jennifer Chee1, Aung N Lin1, Howard Julien1
1Electrophysiology Section, Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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 ± 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.
Insights
Catheter ablation for ventricular arrhythmias from left ventricular papillary muscles is safe for mitral valve function. This study found no significant impact on mitral valve function after ablation procedures, demonstrating safety.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiac Imaging
Background:
- Catheter ablation (CA) effectively treats ventricular arrhythmias (VAs) originating from left ventricular (LV) papillary muscles (PAPs).
- However, CA of LV PAP VAs carries a potential risk of affecting mitral valve (MV) function.
Purpose of the Study:
- To evaluate the impact of CA lesions delivered to LV PAPs on MV function.
- To determine the safety of CA for VAs originating from LV PAPs concerning MV integrity.
Main Methods:
- Retrospective analysis of 103 patients undergoing CA for LV PAP VAs (Jan 2015-Dec 2020).
- Pre- and post-procedural transthoracic echocardiography assessed MV regurgitation severity.
- Radiofrequency ablation utilized irrigated-tip catheters with or without contact force sensing and intracardiac echocardiographic guidance.
Main Results:
- The majority of VAs (55%) originated from the posteromedial PAP.
- Lesions were delivered to various PAP segments, including the tip (50%), base (33%), and body (13%).
- Crucially, 99% of patients (102/103) exhibited no significant change in MV function post-ablation.
Conclusions:
- Intracardiac echocardiographic guidance enables safe lesion delivery to LV PAPs.
- CA of VAs from LV PAPs can be performed without adverse effects on MV function.
Related Concept Videos
01:27Mitral Valve Prolapse I: Introduction
01:22Mitral Stenosis I: Introduction
01:22Mitral Valve Prolapse II: Assessment and Management
01:26Mitral Stenosis III: Medical Management
01:25Mitral Regurgitation III: Medical Management
01:23Mitral Stenosis II: Clinical features and Diagnostic Tests