Electrocardiographic and Electrophysiological Characteristics in Idiopathic Ventricular Arrhythmias Originating From the Papillary Muscles in the Left Ventricle

作者：Takumi Yamada, Harish Doppalapudi, H. Thomas McElderry, Taro Okada, Yoshimasa Murakami, Yasuya Inden, Yukihiko Yoshida, Naoki Yoshida, Toyoaki Murohara, Andrew E. Epstein, Vance J. Plumb, Silvio Hector Litovsky, George Neal Kay · 发表于：Circulation Arrhythmia and Electrophysiology · 年份：2010 · DOI：10.1161/circep.109.922310 · 被引用次数：161 · 研究领域：Cardiac Arrhythmias and Treatments、Atrial Fibrillation Management and Outcomes、Cardiac electrophysiology and arrhythmias

BACKGROUND: Idiopathic ventricular arrhythmias (VAs) can originate from the left ventricular papillary muscles (PAMs). This study investigated the electrophysiological characteristics of these VAs and their relevance for the results of catheter ablation. METHODS AND RESULTS: We studied 19 patients who underwent successful catheter ablation of idiopathic VAs originating from the anterior (n=7) and posterior PAMs (n=12). Although an excellent pace map was obtained at the first ablation site in 17 patients, radiofrequency ablation at that site failed to eliminate the VAs, and radiofrequency lesions in a relatively wide area around that site were required to completely eliminate the VAs in all patients. Radiofrequency current with an irrigated or nonirrigated 8-mm-tip ablation catheter was required to achieve a lasting ablation of the PAM VA origins. During 42% of the PAM VAs, a sharp ventricular prepotential was recorded at the successful ablation site. In 9 (47%) patients, PAM VAs exhibited multiple QRS morphologies, with subtle, but distinguishable differences occurring spontaneously and after the ablation. In 7 (78%) of those patients, radiofrequency lesions on both sides of the PAMs where pacing could reproduce an excellent match to the 2 different QRS morphologies of the VAs were required to completely eliminate the VAs. CONCLUSIONS: Radiofrequency catheter ablation of idiopathic PAM VAs is challenging probably because the VA origin is located relatively deep beneath the en...