Ventricular Arrhythmia Originating from the Left Ventricular Papillary Muscles: Clinical Features and Technical Aspects

Donnelly, Joseph A; Patel, Apoor; Beldner, Stuart

doi:10.19102/icrm.2018.090202

Cited by 4 publications

(3 citation statements)

References 34 publications

(57 reference statements)

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“…However, activation appears to be localized to specific junctions at the base [ 7 ]. This provides an important link between the fascicular tissue and papillary muscle, as reentrant circuits of fascicular VT may involve the Purkinje fibers surrounding the papillary muscles [ 8 ]. The ectopy described in this case has features consistent with both fascicular and papillary muscle origins.…”

Section: Discussionmentioning

confidence: 99%

Short-coupled ventricular ectopics leading to cardiac arrest in a young woman

2022

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Background This case report highlights the importance of recognizing that ventricular ectopy may be a cause for syncope and sudden cardiac death, through triggered disorganized arrhythmia. In the context of syncope, ventricular ectopy should be carefully assessed for coupling interval and morphology. Case presentation A 39-year-old woman, who had presented with recurrent syncope, had a cardiac arrest shortly after admission that required emergency defibrillation. Review of her cardiac monitoring revealed an episode of polymorphic ventricular tachycardia which had degenerated into ventricular fibrillation. The dysrhythmia had been initiated by a short-coupled (R-on-T) ventricular ectopic (VE) beat. Anti-arrhythmic therapy was initiated in the form of hydroquinidine, but the patient continued to have frequent VEs of right bundle branch block (RBBB) morphology with a relatively narrow QRS complex and a variation in frontal axis. A cardiac MRI revealed late gadolinium enhancement of the posterior papillary muscle (indicative of focal scarring). The patient underwent electrophysiological mapping and catheter ablation of her ectopy. The patient made a good recovery and was discharged from hospital with a secondary prevention implantable cardioverter-defibrillator (ICD) in situ. Conclusions Short-couped VEs that are superimposed onto the preceding T wave (R-on-T) are indicative of electrical instability of the heart and should prompt urgent investigation. By studying the morphologies and axes of the QRS complexes produced by VEs, we can identify their likely origins and ascertain their clinical significance.

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Section: Discussionmentioning

confidence: 99%

Short-coupled ventricular ectopics leading to cardiac arrest in a young woman

2022

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“…1 When premature ventricular contraction or ventricular tachycardia ablation fails from an endocardial approach, patients are often sent to specialized centers for consideration for epicardial mapping and ablation. Yet, in many instances, the site of origin of the ventricular arrhythmia is as far away from the epicardium as is anatomically possible: the intracavitary structures, specifically the papillary muscles.…”

Section: In This Issue Of the Journal Of Innovations In Cardiac Rhythmmentioning

confidence: 99%

Ablation of Intracavitary Structures: Anatomy, Anatomy, Anatomy

Bradfield¹,

Shivkumar²

2018

J Innov Cardiac Rhythm Manage

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“… 3 , 4 The noted limitations were problematic catheter maneuverability and smaller lesion size, likely owing to insufficient freezing power for higher myocardial thickness and high thermal load within the ventricle. 5 Ultra-low-temperature cryoablation (ULTC) system (vCLAS™; Adagio Medical, Inc, Laguna Hills, CA) overcomes such limitation by combining high-pressure near-critical nitrogen cryogen at temperature near -196°C, as described elsewhere, with 9F bidirectionally deflectable catheter (≥180 degrees), compatible with 10F steerable and fixed-curve sheath for retrograde or antegrade access. The cryoablation element of the catheter contains 8 electrodes, which are used for mapping, ablation, and pacing.…”

Section: Introductionmentioning

confidence: 99%