Electrocardiographic and electrophysiological characteristics in idiopathic ventricular arrhythmias originating from the papillary muscles in the left ventricle relevance for catheter ablation

Takumi Yamada, Harish Doppalapudi, H. Thomas McElderry, Taro Okada, Yoshimasa Murakami, Yasuya Inden, Yukihiko Yoshida, Naoki Yoshida, Toyoaki Murohara, Andrew E. Epstein, Vance J. Plumb, Silvio H. Litovsky, G. Neal Kay

Research output: Contribution to journalArticlepeer-review

107 Scopus citations

Abstract

Background-Idiopathic ventricular arrhythmias (VAs) can originate from the left ventricular papillary muscles (PAMs). This study investigated the electrophysiological characteristics of these VAs and their relevance for the results of catheter ablation. Methods and Results-We studied 19 patients who underwent successful catheter ablation of idiopathic VAs originating from the anterior (n=7) and posterior PAMs (n=12). Although an excellent pace map was obtained at the first ablation site in 17 patients, radiofrequency ablation at that site failed to eliminate the VAs, and radiofrequency lesions in a relatively wide area around that site were required to completely eliminate the VAs in all patients. Radiofrequency current with an irrigated or nonirrigated 8-mm-tip ablation catheter was required to achieve a lasting ablation of the PAM VA origins. During 42% of the PAM VAs, a sharp ventricular prepotential was recorded at the successful ablation site. In 9 (47%) patients, PAM VAs exhibited multiple QRS morphologies, with subtle, but distinguishable differences occurring spontaneously and after the ablation. In 7 (78%) of those patients, radiofrequency lesions on both sides of the PAMs where pacing could reproduce an excellent match to the 2 different QRS morphologies of the VAs were required to completely eliminate the VAs. Conclusions-Radiofrequency catheter ablation of idiopathic PAM VAs is challenging probably because the VA origin is located relatively deep beneath the endocardium of the PAMs. PAM VAs often exhibit multiple QRS morphologies, which may be caused by a single origin with preferential conduction resulting from the complex structure of the PAMs.

Original languageEnglish (US)
Pages (from-to)324-331
Number of pages8
JournalCirculation: Arrhythmia and Electrophysiology
Volume3
Issue number4
DOIs
StatePublished - Aug 2010
Externally publishedYes

Keywords

  • Cardiac arrhythmias
  • Electrophysiology
  • Idiopathic
  • Papillary muscles
  • Radiofrequency catheter ablation

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