Catheter ablation of premature ventricular complexes associated with left ventricular false tendons

Idiopathic ventricular fibrillation triggered by premature ventricular complexes originating from the false tendon of the left ventricle

“…The origin of PVCs was noted to be the sites of attachment of the false tendon to the LV septum, papillary muscle, or LV apex. High-frequency Purkinje potentials were observed in 7 of 10 patients at the target sites of ablation over the LVFT with the earliest timing pre-PVC being 36 ms. 7 Interestingly, in our patient, we noted a very early high-frequency Purkinje potential (101 ms pre-PVC), as shown in Figure 2B . Usually such early Purkinje/conduction system potentials are observed in bundle branch VT or fascicular VT.…”

“…4 , 5 Very few studies have looked at outcomes after radiofrequency (RF) catheter ablation in PVCs originating from the LVFT. 6 , 7 Our case is a rare presentation of PVCs originating from the LVFT triggering VF in a patient without structural heart disease.…”

“…Zhang and colleagues 7 have described 10 patients with PVCs originating from the LVFT and successful RF ablation using an ICE-guided electroanatomical approach. The origin of PVCs was noted to be the sites of attachment of the false tendon to the LV septum, papillary muscle, or LV apex.…”

“…The mechanisms of PVCs originating from LVFTs may be owing to the increased automaticity of Purkinje cells within muscle fibers or increased excitability owing to mechanical traction at the false tendon attachment site. 7 …”

Intracardiac echocardiography Chinese expert consensus

“…However, definitive differentiation between the two based on ECG and EP is sometimes difficult. In fact, it has been proved that the mechanism of a part of fascicular ventricular tachycardia is closely related to such structures as Purkinje fibers and false tendons around the papillary muscles ( 75 ). For this part of left posterior fascicular ventricular tachycardia, the target for successful ablation may not be conventionally in the left mid-posterior septum, but around such anatomical structures as the left posterior papillary muscle and/or the false tendon attached to it.…”