EP Fellows Curriculum: Catheter Ablation of Papillary Muscle Ventricular Arrhythmias-EP Fellows Curriculum: Catheter Ablation of Papillary Muscle Ventricular Arrhythmias

Video Transcription

Video Summary

Papillary muscle ventricular arrhythmias are becoming more common and are presenting with a variety of symptoms. The most common presentation is premature ventricular complexes (PVCs) followed by non-sustained ventricular tachycardia (VT). The distinguishing ECG features of left ventricular capillary muscle ventricular arrhythmias include a right bundle branch block morphology, late precordial transition beyond V4, and the presence of an initial Q wave in V1. During capture ablation of the papillary muscle ventricular arrhythmia, the target site is identified by finding the earliest site of activation, which may or may not show sharp P wave activity. When discussing management options for papillary muscle ventricular arrhythmias, it is important to treat symptomatic patients or asymptomatic patients with a high arrhythmia burden. Catheter ablation is generally preferred as the first choice, but antiarrhythmics may also be used. The success rate of catheter ablation has improved with the use of ICE-guided mapping and contact force sensing. Challenges of the procedure include the dynamic and variable anatomy of the papillary muscles, as well as potential complications such as catheter entrapment and myocardial perforation. Overall, the management of papillary muscle ventricular arrhythmias requires a careful approach with a combination of mapping techniques and consideration of each patient's individual characteristics.

Keywords

Papillary muscle ventricular arrhythmias

symptoms

premature ventricular complexes

non-sustained ventricular tachycardia

ECG features

left ventricular capillary muscle ventricular arrhythmias

capture ablation

target site

management options

Catheter ablation