title: Results of Cryoenergy and Radiofrequency-Based Catheter Ablation for Treating Ventricular Arrhythmias Arising From the Papillary Muscles of the Left Ventricle, Guided by Intracardiac Echocardiography and Image Integration.
abstract: BACKGROUND
  Catheter radiofrequency ablation of ventricular arrhythmias (VAs) arising from the left ventricle's papillary muscles has been associated with inconsistent results. The use of cryoenergy versus radiofrequency has not been compared yet. This study compares outcomes and complications of catheter ablation of VA from the papillary muscles of the left ventricle with either cryoenergy or radiofrequency.
  
  
  RESULTS
  Twenty-one patients (40±12 years old; 47% males; median ejection fraction 59±7.3%) with drug refractory premature ventricular contractions or ventricular tachycardia underwent catheter cryoablation or radiofrequency ablation. VAs were localized using 3-dimensional mapping, multidetector computed tomography, and intracardiac echocardiography, with arrhythmia foci being mapped at either the anterolateral papillary muscle or posteromedial papillary muscles of the left ventricle. Focal ablation was performed using an 8-mm cryoablation catheter or a 4-mm open-irrigated radiofrequency catheter, via transmitral approach. Acute success rate was 100% for cryoenergy (n=12) and 78% for radiofrequency (n=9; P=0.08). Catheter stability was achieved in all patients (100%) treated with cryoenergy, and only in 2 (25%) patients treated with radiofrequency (P=0.001). Incidence of multiple VA morphologies was observed in 7 patients treated with radiofrequency (77.7%), whereas none was observed in those treated with cryoenergy (P=0.001). VA recurrence at 6 months follow-up was 0% for cryoablation and 44% for radiofrequency (P=0.03).
  
  
  CONCLUSIONS
  Cryoablation was associated with higher success rates and lower recurrence rates than radiofrequency catheter ablation, better catheter stability, and lesser incidence of polymorphic arrhythmias.
authors.affiliation: From the Cardiovascular Institute of Buenos Aires (ICBA), Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina. riv.santiago@gmail.com.
authors.forename: Santiago
authors.initials: S
authors.lastname: Rivera
authors.affiliation: From the Cardiovascular Institute of Buenos Aires (ICBA), Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Maria de la Paz
authors.initials: Mde L
authors.lastname: Ricapito
authors.affiliation: From the Cardiovascular Institute of Buenos Aires (ICBA), Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Leandro
authors.initials: L
authors.lastname: Tomas
authors.affiliation: From the Cardiovascular Institute of Buenos Aires (ICBA), Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Josefina
authors.initials: J
authors.lastname: Parodi
authors.affiliation: From the Cardiovascular Institute of Buenos Aires (ICBA), Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Bardera Molina
authors.affiliation: From the Cardiovascular Institute of Buenos Aires (ICBA), Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Banega
authors.affiliation: From the Cardiovascular Institute of Buenos Aires (ICBA), Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Pablo
authors.initials: P
authors.lastname: Bueti
authors.affiliation: From the Cardiovascular Institute of Buenos Aires (ICBA), Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Agustin
authors.initials: A
authors.lastname: Orosco
authors.affiliation: From the Cardiovascular Institute of Buenos Aires (ICBA), Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Reinoso
authors.affiliation: From the Cardiovascular Institute of Buenos Aires (ICBA), Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Milagros
authors.initials: M
authors.lastname: Caro
authors.affiliation: From the Cardiovascular Institute of Buenos Aires (ICBA), Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Diego
authors.initials: D
authors.lastname: Belardi
authors.affiliation: From the Cardiovascular Institute of Buenos Aires (ICBA), Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Gaston
authors.initials: G
authors.lastname: Albina
authors.affiliation: From the Cardiovascular Institute of Buenos Aires (ICBA), Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Alberto
authors.initials: A
authors.lastname: Giniger
authors.affiliation: From the Cardiovascular Institute of Buenos Aires (ICBA), Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Fernando
authors.initials: F
authors.lastname: Scazzuso
mesh_terms: D000328:Adult; D017115:Catheter Ablation / Q000379:methods*; D003452:Cryosurgery / Q000379:methods*; D004452:Echocardiography / Q000379:methods*; D004562:Electrocardiography; D019160:Endosonography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D010210:Papillary Muscles / Q000294:innervation / Q000601:surgery; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted / Q000379:methods*; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*
keywords: catheter ablation; echocardiography; incidence; papillary muscles; ventricular tachycardia