Catheter Ablation -> Ventricular Arrhythmias -> Experimental methods D-MP04 - New Horizons in Catheter Ablation (ID 22) Moderated ePoster

D-MP04-05 - First Report Of Papillary Muscle PVC Ablation Under Direct Visualization At The Time Of MV Surgery: A Therapeutic Consideration For Arrhythmic MVP (ID 9)


Background: Papillary muscle PVCs are a common finding in patients with mitral valve prolapse (MVP). In some patients, the PVCs can trigger VT/VF or result in a cardiomyopathy. Mitral valve repair has not been shown to have a significant impact on PVC burden. Catheter ablation of papillary muscle (PM) PVCs is modestly effective (≈ 60%), but repeat ablation is frequently necessary.
Objective: To describe the effect of cryoablation of PM PVCs, performed under direct visualization, at the time of MV surgery in patients with Arrhythmic MVP and a high burden of PVCs.
Methods: We included 3 patients with Arrhythmic MVP (Barlow’s) who were planned for MV repair and had a surface ECG localizing the origin of at least one PVC to a papillary muscle region, and consented to the hybrid ablation procedure. Cryolesions were 2 min per lesion, and 2 lesions per Pap Muscle (Atricure probe), with a goal to target the head of the Pap Muscle. The PVC burden was quantified with either Holter monitoring or device interrogation.
Results: Two of 3 pts had a history of cardiac arrest due to VF. In 1 pt both PMs were ablated, while only the postero-medial PM was ablated in 2 pts. The reductions in PVCs burden for the 3 pts were 93% (both PMs), 99%, and 51% (this latter pt was also known to have outflow PVCs), at follow-up. Follow-up echo demonstrated no impact on MV function, and there were no surgical complications.
Conclusion: In patients with Arrhythmic MVP and a high burden of PVCs, direct cryoablation of the papillary muscle, at the time of MV surgery, may significantly decrease PVC burden. Larger studies are need to confirm the efficacy and safety of this approach.