Document Detail

Ventricular tachycardia originating from the posterior papillary muscle in the left ventricle: a distinct clinical syndrome.
MedLine Citation:
PMID:  19808390     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Several distinct forms of focal ventricular tachycardia (VT) from the left ventricle (LV) have been described. We report a new syndrome of VT arising from the base of the posterior papillary muscle in the LV. METHODS AND RESULTS: Among 290 consecutive patients who underwent ablation for VT or symptomatic premature ventricular complexes (PVCs) based on a focal mechanism, 7 patients were found to have an ablation site at the base of the posterior papillary muscle in the LV. All patients had normal LV systolic function and a normal baseline electrocardiogram. The electrocardiogram during VT or PVCs demonstrated a right bundle-branch block and superior-axis QRS morphology in all patients. VT was not inducible by programmed atrial or ventricular stimulation. In 2 patients with sustained VT, overdrive pacing neither terminated VT nor demonstrated any criterion for transient entrainment. Activation mapping localized the earliest site of activation to the base of the posterior papillary muscle in all patients. When Purkinje potentials were recorded at the site of successful ablation, these potentials preceded local ventricular muscle potentials during sinus rhythm. During VT or PVCs, however, the ventricular muscle potential always preceded the Purkinje potentials. After recurrence of VT or PVCs with standard radiofrequency ablation, irrigated ablation was successful in eliminating the arrhythmia in all patients. Over a mean follow-up period of 9 months, all patients have been free of PVCs and VT. CONCLUSIONS: We present a distinct syndrome of VT arising from the base of the posterior papillary muscle in the LV by a nonreentrant mechanism. Ablation can be challenging, and irrigated ablation may be necessary for long-term success.
Harish Doppalapudi; Takumi Yamada; H Thomas McElderry; Vance J Plumb; Andrew E Epstein; G Neal Kay
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Circulation. Arrhythmia and electrophysiology     Volume:  1     ISSN:  1941-3084     ISO Abbreviation:  Circ Arrhythm Electrophysiol     Publication Date:  2008 Apr 
Date Detail:
Created Date:  2009-10-07     Completed Date:  2009-10-26     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101474365     Medline TA:  Circ Arrhythm Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  23-9     Citation Subset:  IM    
Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
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MeSH Terms
Action Potentials
Aged, 80 and over
Bundle-Branch Block / etiology,  physiopathology
Cardiac Pacing, Artificial
Catheter Ablation / methods
Diagnosis, Differential
Electrophysiologic Techniques, Cardiac
Heart Ventricles / physiopathology
Middle Aged
Papillary Muscles / physiopathology*
Purkinje Fibers / physiopathology
Tachycardia, Ventricular / diagnosis,  etiology,  physiopathology*,  surgery
Time Factors
Treatment Outcome
Ventricular Function, Left
Ventricular Premature Complexes / diagnosis,  etiology,  physiopathology*,  surgery

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