Catheter Ablation For Papillary Muscle Arrhythmias A Systematic Review

Background: Catheter ablation of papillary muscle ventricular arrhythmias (PM-VAs) has been associated with unsatisfactory results. Features that may affect acute and long-term procedural outcomes are not well established. Objective: To systematically review the available data in the literature assessing efficacy and safety of PM-VAs catheter ablation. Methods: An online search of Pubmed, Cochrane Registry, Web of Science, Scopus and EMBASE libraries (from inception to March, 1 2021) was performed, in addition to manual screening. Twenty-one observational non-controlled case-series were considered eligible for the systematic review, including 536 patients. Results: Postero-medial PM harbored 60.8% of PM-VAs, while antero-lateral PM and right ventricular PMs 34.9% and 4.3% of cases, respectively. The mean acute success rate of the index ablation procedure was 88.1% (95% CI 82.8%-91.9%, p < 0.001, I2 0%). After a mean follow-up period of 15.5 ± 17.4 months, pooled long-term arrhythmia-free rate was 69.2%, while the pooled long-term success rate after multiple ablation procedure was 84.9%. Overall, procedure complications occurred in 9 patients (1.7%) and no procedure-related deaths were reported. The use of intracardiac echocardiography (ICE) as well as contact force sensing (CFS) and irrigated catheters during ablation was associated with higher rates of arrhythmia-freedom at long-term follow-up. Conclusions: Catheter ablation is an effective and safe strategy for PM-VAs, with an acute success rate of 88.1%, a long-term success rate of 69.2%, with a relatively low procedural complication rate. The use of ICE, irrigated catheters and catheters with CFS capability was associated with higher rates of arrhythmia-freedom at long-term follow-up.