Intra cardiac echo guided papillary muscle origin Premature Ventricular Contraction (PVCs)/ Ventricular Tachycardia (VT) ablation: A case series

Abstract

Background: Papillary muscle (PM) premature ventricular complexes (PVCs) and ventricular tachycardias (VTs) pose unique challenges due to their deep origin, anatomical mobility, and proximity to valvular structures. Intracardiac echocardiography (ICE) has emerged as a valuable tool for real-time anatomical visualization and catheter guidance.

Aim: To evaluate the safety, feasibility, and outcomes of ICE-guided radiofrequency ablation of papillary muscle PVC/VT in a series of patients.

Methods: We retrospectively analyzed 10 patients (mean age ~54 years; 80% of male) with symptomatic, PM PVCs/VTs. Etiologies included ischemic heart disease (4), inflammatory cardiomyopathy (1), and idiopathic causes (6). 5 presented with premature ventricular contractions, 5 with ventricular tachycardia, and 1 with VT storm. All patients underwent high-density electroanatomical mapping. ICE guidance was employed in all cases to enhance catheter stability and visual confirmation of contact. Mapping sites included the LV anterolateral (3), LV posteromedial (5), RV posterior (1) PMs of both ventricles. Access routes included transaortic (6), transeptal (4), and right ventricular (1) approaches.

Results: Acute procedural success (suppression of clinical PVC/VT – 100%, & elimination of PVC in 80%) was achieved. No procedural complications were reported. Patients with ICE guidance had superior catheter stability and fewer energy applications. During follow-up, 10 of 11 patients remained free from recurrence.

Conclusion: ICE-guided PM PVC/VT ablation is a safe and highly effective strategy. Its use enhances catheter control and mapping accuracy, leading to better outcomes in these anatomically complex substrates