Combination of Intracardiac Echocardiography and Contact Force Sensing for Left Ventricular Papillary Muscle Arrhythmias

Tongshuai Chen; Lujie Chang; Bing Rong; Kai Zhang; Guanqi Fan; Jing Kong; Mingying Ling; Qingyu Kong; Kellina Maduray; Cuifen Zhao; Jingquan Zhong

doi:10.3390/jcm12093154

Combination of Intracardiac Echocardiography and Contact Force Sensing for Left Ventricular Papillary Muscle Arrhythmias

J Clin Med. 2023 Apr 27;12(9):3154. doi: 10.3390/jcm12093154.

Authors

Tongshuai Chen¹, Lujie Chang², Bing Rong³, Kai Zhang¹, Guanqi Fan⁴, Jing Kong¹, Mingying Ling³, Qingyu Kong², Kellina Maduray¹, Cuifen Zhao², Jingquan Zhong^{1

5}

Affiliations

¹ National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Department of Cardiology, Qilu Hospital of Shandong University, Jinan 250012, China.
² Department of Pediatric Cardiology, Qilu Hospital of Shandong University, Jinan 250012, China.
³ Department of Geriatric Medicine, Qilu Hospital of Shandong University, Jinan 250012, China.
⁴ Department of Radiology, Qilu Hospital of Shandong University, Jinan 250012, China.
⁵ Department of Cardiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Jinan 250012, China.

Abstract

Objectives: The catheter ablation of ventricular arrhythmias (VAs) arising from the left ventricular (LV) papillary muscles (PMs) is challenging. This study sought to address whether the combination of intracardiac echocardiography (ICE) and contact force sensing (CFS) can improve the acute and long-term ablation outcomes of left ventricular papillary muscle arrhythmias.

Methods and results: From May 2015 to August 2022, a total of thirty-three patients underwent catheter ablation for LV PM arrhythmias: VAs were located in anterolateral PMs in 11 and posteromedial PMs in 22. A combination of intracardiac echocardiography (ICE) and contact force sensing (CFS) was used in 21 of the 33 procedures. A mean of 6.93 ± 4.91 for lesions was used per patient, 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 the ICE/CFS group was 7.52 ± 3.31 g. Less X-ray time was used in the combination group (CFS/ICE: 165.67 ± 47.80 S vs. no ICE/CFS: 365.00 ± 183.73 S; p < 0.001). An acute success rate of 100% was achieved for the ICE/CFS group (n = 22) and 66.67% for the no ICE/CFS group (n = 8). VA recurrence at the 11.21 ± 7.21-month follow-up was 14.2% for the ICE/CFS group and 50% for the no ICE/CFS group (p = 0.04). No severe complications occurred in all patients.

Conclusions: The combination of intracardiac echocardiography (ICE) and contact force sensing (CFS) could provide precise geometries of cardiac endocavitary structures and accurate contact information for the catheter during ablation, which improved acute and long-term ablation outcomes. The routine adoption of this strategy should be considered to improve the outcomes of LV PM VA ablation.

Keywords: catheter ablation; contact force sensing; intracardiac echocardiography; left ventricular arrhythmias; papillary muscles.

Grants and funding

National Natural Science Foundation of China, 82270331; National Natural Science Foundation for Young Scientists of China, 81700366, 82100472; Qingdao Key Health Discipline Development Fund, QDZDZK-2022008, Key R&D project of Shandong Province 2019GSF108186, Science and Technology Foundation of Jinan City 201805057; Medical and Health Science and Technology Development Foundation of Shandong Province 2016WS0366.