Idiopathic Ventricular Arrhythmias Originating from the Papillary Muscles in the Left Ventricle: Prevalence, Electrocardiographic and Electrophysiological Characteristics, and Results of the Radiofrequency Catheter Ablation

Abstract

There are differences in the electrocardiographic and electrophysiological features among VAs originating from these regions that are helpful for their diagnosis and effective catheter ablation.

Anatomical Consideration in Catheter Ablation of Idiopathic Ventricular Arrhythmias

“…6,15 Pacing within the aortic coronary cusps often exhibits a long stimulus to QRS interval (more likely in the LCC than the RCC) whereas pacing below the aortic valves gives no latency between the pacing stimulus and QRS onset. There is a potential risk of aortic insufficiency.…”

“…2,6,10 Calcifications of the coronary arteries in older patients may also facilitate delineation of the ostia of the coronary arteries. The three aortic coronary cusps can be readily identified during biplane aortography or coronary angiography.…”

“…21 IVAs can arise from the Purkinje network, most commonly from the left posterior fascicle followed by the anterior and septal fascicles. 19,22,23 The anterior fascicle runs along the mitral annulus, and the peripheral Purkinje network extends to the surface of the papillary muscles and moderator band. Therefore, these IVAs have to be differentiated from IVAs originating from the papillary muscles, moderator band and AV annuli.…”

“…7,8 Tricuspid annular IVAs can originate from any region along the tricuspid annulus, but more often originate from the septal aspect, especially in the anteroseptal or para-Hisian region than the free wall. 15 IVAs can arise from intracavitary structures including the papillary muscles [16][17][18][19][20] and moderator band. 21 LV papillary muscle IVAs are known to arise more commonly from the postero-medial papillary muscle than the anterolateral papillary muscle.…”

Ablation of ventricular arrhythmias above semilunar valves.

“…Razvojem elektrofiziologije shvatilo se da znaËajan dio tih aritmija moaee dolaziti i iz izlaznog trakta lijeve klijetke (LVOT), a u tim sluËajevima je supstrat dominantno smjeπten supravalvularno 1 . Suvremeni prikazi serija pacijenata s ovim entitetom upuÊu-ju da supravalvularne ventrikularne aritmije Ëine Ëak oko 16% od ukupnog broja pacijenata s idiopatskim ventrikularnim aritmijama, πto daje naslutiti da je ovaj entitet bio u proπlosti nedovoljno shvaÊen i u veÊine pacijenata previen 2 .…”