Combination of intracardiac echocardiography and contact force sensing for left ventricular papillary muscle arrhythmias

Abstract Objectives Catheter ablation of ventricular arrhythmias (VAs) arising from the left ventricular (LV) papillary muscles (PM) is challenging. This study sought to address whether combination of intracardiac echocardiography (ICE) and contact force sensing (CFS) can improve acute and long-term ablation outcomes of left ventricular papillary muscle arrhythmias. Methods and Results From May 2015 to August 2022, a total thirty-three patients underwent catheter ablation for LV PM arrhythmias: VAs was located in anterolateral PM in 11, posteromedial PM in 22. Combination of intracardiac echocardiography (ICE) and contact force sensing (CFS) was used in 21 of the 33 procedures. The mean 6.93±4.91 lesions were used per patient and were comparable between the CFS/ICE and No ICE/CFS (4.90±2.23 vs. 10.17±5.89; P=0.011).The mean CF achieved in ICE/CFS group were 7.52±3.31g. Less X-ray time were used in combination group (CFS/ICE: 165.67±47.80 S vs. No ICE/CFS: 365.00±183.73 S; P<0.001). Acute success rate was 100% for ICE/CFS group (n=22) and 66.67% for No ICE/CFS group (n=8). VAs recurrence at 11.21±7.21 months follow-up was 14.2% for ICE/CFS group and 50.00% for No ICE/CFS group (P=0.04). No severe complications occurred in all patients. Conclusion Combination of intracardiac echocardiography (ICE) and contact force sensing (CFS) can provide precise geometries of cardiac endo cavitary structures and accurate contact information of catheter during ablation, which improved acute and long-term ablation outcomes. Routine adoption of this strategy should be considered to improve outcomes of LV PM VAs ablation.