Relationship of Structural Abnormalities of Papillary Muscles to the Site of Origin of Ventricular Arrhythmias

IF 8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Clinical electrophysiology Pub Date : 2025-02-01 DOI:10.1016/j.jacep.2024.10.004

Nithi Tokavanich MD , Anurut Huntrakul MD , Miki Yokokawa MD , Boldizsar Kovacs MD , Michael Ghannam MD , Jackson L. Liang DO , Anil Attili MD , Hubert Cochet MD , Rakesh Latchamsetty MD , Krit Jongnarangsin MD , Fred Morady MD , Frank Bogun MD

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引用次数: 0

Abstract

Background

Arrhythmias originating from papillary muscles (PAPs) can be challenging when targeted with catheter ablation. The prevalence and impact of structural abnormalities on PAPs in patients with focal PAP arrhythmias is unknown.

Objectives

The purpose of this study was to analyze, in a consecutive patient series with focal PAP arrhythmias, the impact of structural abnormalities detected by multimodality imaging.

Methods

In a series of 43 consecutive patients with focal PAP arrhythmias referred for ablation, the prevalence and location of structural abnormalities on PAPs were assessed with cardiac magnetic resonance imaging, computed tomographic angiography and intracardiac echocardiography (ICE). Sites of origin of ventricular arrhythmias (VAs) were correlated with structural abnormalities.

Results

On PAPs, late gadolinium enhancement (LGE) was present on cardiac magnetic resonance imaging in 19 of 43 patients, calcifications on computed tomography in 2 of 43 and on ICE in 3 of 43 patients, and increased echogenicity on ICE in 39 of 43 patients. A total of 141 focal PAP arrhythmias were identified, and VA target sites were localized adjacent to areas with increased echogenicity on ICE for 59 of 141 (44%) VAs, adjacent to LGE for 35 of 141 (25%) VAs, and adjacent to calcifications for 14 of 141 (10%) VAs. At least one VA target site was localized to areas of structural abnormalities in 32 of 43 (74%) patients.

Conclusions

Multimodality imaging identifies arrhythmogenic PAPs preprocedurally and in real time during the ablation procedure in most patients. Increased echogenicity, LGE, and calcifications are often seen on PAPs in patients with focal PAP arrhythmias and can indicate the site of origin.

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乳头状肌结构异常与室性心律失常发病部位的关系。

背景：起源于乳头状肌（PAPs）的心律失常在导管消融的靶向治疗中是具有挑战性的。局灶性PAP心律失常患者PAP结构异常的患病率和影响尚不清楚。目的：本研究的目的是分析连续的局灶性PAP心律失常患者系列，多模态成像检测到的结构异常的影响。方法：对43例连续行消融术的局灶性PAP心律失常患者，采用心脏磁共振成像、计算机断层血管造影和心内超声心动图（ICE）评估PAP结构异常的发生率和位置。室性心律失常（VAs）的起源部位与结构异常相关。结果：43例pap患者中，19例出现心脏磁共振晚期钆增强（LGE）， 43例中2例出现计算机断层钙化，43例中3例出现ICE钙化，43例中39例出现ICE回声增强。共发现141例局灶性PAP心律失常，141例VAs中有59例（44%）位于ICE回声增强区附近，35例（25%）位于LGE附近，14例（10%）位于钙化区附近。43例患者中有32例（74%）至少有一个VA靶位定位于结构异常区域。结论：多模态成像可在大多数患者术前和消融过程中实时识别致心律失常的pap。在局灶性PAP心律失常患者的PAP上，回声增强、LGE和钙化常被发现，可以提示发病部位。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JACC. Clinical electrophysiology CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

10.30

自引率

5.70%

发文量

250

期刊介绍： JACC: Clinical Electrophysiology is one of a family of specialist journals launched by the renowned Journal of the American College of Cardiology (JACC). It encompasses all aspects of the epidemiology, pathogenesis, diagnosis and treatment of cardiac arrhythmias. Submissions of original research and state-of-the-art reviews from cardiology, cardiovascular surgery, neurology, outcomes research, and related fields are encouraged. Experimental and preclinical work that directly relates to diagnostic or therapeutic interventions are also encouraged. In general, case reports will not be considered for publication.