Ventricular Tachycardia Originating from the Septal Papillary Muscle of the Right Ventricle: Electrocardiographic and Electrophysiological Characteristics. (5th November 2014)

• Record Type: Journal Article
• Authors: SANTORO, FRANCESCO; DI BIASE, LUIGI; HRANITZKY, PATRICK; SANCHEZ, JAVIER E.; SANTANGELI, PASQUALE; PERINI, ALESSANDRO PAOLETTI; BURKHARDT, JOHN DAVID; NATALE, ANDREA
• Is Part Of: Journal of cardiovascular electrophysiology. Volume 26:Number 2(2015:Feb.)
• Page Start: 145
• Page End: 150
• Publication Date: 2014-11-05
• Subjects: Blood vessels -- Physiology -- Periodicals; Electrophysiology -- Periodicals; Heart -- Physiology -- Periodicals; 612.1
• DOI: 10.1111/jce.12551
• Languages: English
• ISSNs: 1045-3873

Abstract

<abstract abstract-type="main"> <title>RV Septal Papillary Muscle VT</title> <sec id="jce12551-sec-0010" sec-type="section"> <title>Introduction</title> <p>Premature ventricular complexes (PVCs) and ventricular tachycardia (VT) arising from papillary muscles of both ventricles have recently been described. There is a lack of data on VT originating from the right ventricular papillary (RV PAP) muscles. There have been no prior studies focused on the electrocardiogram (ECG) features and ablation of PVC/VT arising from the septal papillary muscle of the right ventricle.</p> </sec> <sec id="jce12551-sec-0020" sec-type="section"> <title>Methods</title> <p>Among 155 consecutive patients with normal structural heart who underwent catheter ablation of PVC/VT, 8 patients with PVC/VT from the septal RV PAP muscle were identified. The site of origin of the arrhythmias was identified through activation/pace mapping and intracardiac echocardiography. All patients underwent radiofrequency ablation of the arrhythmia.</p> </sec> <sec id="jce12551-sec-0030" sec-type="section"> <title>Results</title> <p>Data on 8 consecutive patients (2 men, age 42 ± 13 years old) were collected. All patients had a preserved ejection fraction (60 ± 4%). Septal RV PAP arrhythmias had a left superior axis and negative concordance or late R‐wave transition in precordial leads.</p> <p>PVCs were spontaneous in 5 cases, were induced by isoprotenerol in 2 cases and by isoproterenol plus phenylephrine in another one. PVCs were never induced with calcium bolus and only rarely with burst pacing. Adenosine never terminated VT or suppressed the VT/PVCs.</p> <p>Radiofrequency, fluoroscopic, and procedural time were, respectively, 10.3 ± 3, 36.4 ±11.3, and 76.3 ± 27.5 minutes. During a mean follow‐up of 8 ± 4 months, mean PVC burden was reduced from 14 ± 3% preablation to 0.1 ± 0.2% postablation.</p> </sec> <sec id="jce12551-sec-0040" sec-type="section"> <title>Conclusion</title> <p>PVCs and VT originating from septal RV papillary muscle could have a typical ECG pattern due to the site of the muscle involved. Radiofrequency ablation of this anatomic area is feasible and effective.</p> </sec> </abstract>