| Ventricular arrhythmias originating from a papillary muscle in patients without prior infarction: a comparison with fascicular arrhythmias. | |
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MedLine Citation:
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PMID: 18984528 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: The papillary muscles (PAP) have been implicated in arrhythmogenesis, largely based on theoretical considerations and experimental studies. Few clinical studies have described papillary muscle arrhythmias. OBJECTIVE: This study sought to describe ventricular arrhythmias arising from the left ventricular PAPs in a consecutive series of patients without prior myocardial infarction and to compare these arrhythmias with fascicular arrhythmias. METHODS: Nine of 122 consecutive patients (7%) presenting with symptomatic premature ventricular complexes (PVCs) or nonsustained ventricular tachycardia (VT) were found to have a site of origin in the anterolateral or posteromedial left ventricular PAP. Their mean age was 57 +/- 9 years, and the mean ejection fraction was 0.49 +/- 13. Four of 9 patients had idiopathic cardiomyopathy. The PAP involvement was established by intracardiac echocardiography. Eight of the 122 patients (6.5%) had idiopathic VT originating in the left anterior or posterior fascicle, and these patients served as a control group. RESULTS: Compared with patients with fascicular arrhythmias, the QRS width was significantly greater in patients with PAP arrhythmias (150 +/- 15 ms vs. 127 +/- 11 ms; P = .001). Presystolic Purkinje potentials were identified at all effective ablation sites for fascicular arrhythmias, but in arrhythmias originating from PAPs, more distal Purkinje potentials often were recorded from the Purkinje-myocardial interface located at the PAP. All arrhythmias originating from the PAPs and the fascicles were effectively ablated. Echocardiography before and after radiofrequency ablation did not show new or worsened mitral insufficiency. CONCLUSION: The PAPs can give rise to ventricular arrhythmias in normal and structurally abnormal hearts without prior infarcts. Intracardiac echocardiography seems helpful in recognizing and guiding radiofrequency ablation of PAP arrhythmias. |
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Authors:
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Eric Good; Benoit Desjardins; Krit Jongnarangsin; Hakan Oral; Aman Chugh; Matthew Ebinger; Frank Pelosi; Fred Morady; Frank Bogun |
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Publication Detail:
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Type: Comparative Study; Journal Article Date: 2008-09-03 |
Journal Detail:
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Title: Heart rhythm : the official journal of the Heart Rhythm Society Volume: 5 ISSN: 1556-3871 ISO Abbreviation: Heart Rhythm Publication Date: 2008 Nov |
Date Detail:
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Created Date: 2008-11-05 Completed Date: 2009-03-26 Revised Date: 2009-10-27 |
Medline Journal Info:
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Nlm Unique ID: 101200317 Medline TA: Heart Rhythm Country: United States |
Other Details:
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Languages: eng Pagination: 1530-7 Citation Subset: IM |
Affiliation:
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University of Michigan Medical Center, Ann Arbor, Michigan, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Bundle of His
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physiopathology* Catheter Ablation Echocardiography Female Humans Male Middle Aged Myocardial Infarction Papillary Muscles / physiopathology* Tachycardia, Ventricular / physiopathology*, surgery, ultrasonography* |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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