TY - JOUR
T1 - Ventricular fibrillation triggered by PVCs from papillary muscles
T2 - Clinical features and ablation
AU - Santoro, Francesco
AU - Biase, Luigi Di
AU - Hranitzky, Patrick
AU - Sanchez, Javier E.
AU - Santangeli, Pasquale
AU - Perini, Alessandro Paoletti
AU - Burkhardt, John David
AU - Natale, Andrea
N1 - Publisher Copyright:
© 2014 Wiley Periodicals, Inc.
PY - 2014/11/1
Y1 - 2014/11/1
N2 - VF from Papillary Muscle Background Animal studies showed that papillary muscles can be sources of ventricular fibrillation (VF) in both the left and right ventricle, but this occurrence in humans has been described only in patients with ischemic heart disease. Objective To investigate the role of papillary muscle premature ventricular contractions (PVCs) as triggers for VF and the safety and feasibility of catheter ablation in these patients.Methods Six patients (2 male; age, 40 ± 11 years; 5 with a normal structural heart and 1 with nonischemic cardiomyopathy) with history of VF resulting in repetitive implantable cardioverter defibrillator shocks, despite antiarrhythmic drug therapy, and a papillary muscle focus of PVCs triggering VF were included and underwent mapping and ablation of PVCs.Results PVCs were observed to trigger VF and localized by mapping the earliest activation point that matched pace mapping of the same area. In 2 patients, PVCs originated from the left ventricle at the posteromedial papillary muscle; in 4 patients, PVCs originated from the right ventricle, at the posterolateral papillary muscle. Elimination of the triggering PVC was obtained in these areas after 19 ± 12 minutes by radiofrequency application. During a follow-up of 58 ± 11 months using ambulatory monitoring and defibrillator memory interrogation, no patients had recurrence of symptomatic ventricular arrhythmias.Conclusion Papillary muscles from both ventricles represent an anatomic structure potentially involved in the onset of VF, also in normal structural heart. PVCs arising from this area can be successfully eliminated by radiofrequency ablation, resulting in freedom from recurrent VF at long-term follow-up.
AB - VF from Papillary Muscle Background Animal studies showed that papillary muscles can be sources of ventricular fibrillation (VF) in both the left and right ventricle, but this occurrence in humans has been described only in patients with ischemic heart disease. Objective To investigate the role of papillary muscle premature ventricular contractions (PVCs) as triggers for VF and the safety and feasibility of catheter ablation in these patients.Methods Six patients (2 male; age, 40 ± 11 years; 5 with a normal structural heart and 1 with nonischemic cardiomyopathy) with history of VF resulting in repetitive implantable cardioverter defibrillator shocks, despite antiarrhythmic drug therapy, and a papillary muscle focus of PVCs triggering VF were included and underwent mapping and ablation of PVCs.Results PVCs were observed to trigger VF and localized by mapping the earliest activation point that matched pace mapping of the same area. In 2 patients, PVCs originated from the left ventricle at the posteromedial papillary muscle; in 4 patients, PVCs originated from the right ventricle, at the posterolateral papillary muscle. Elimination of the triggering PVC was obtained in these areas after 19 ± 12 minutes by radiofrequency application. During a follow-up of 58 ± 11 months using ambulatory monitoring and defibrillator memory interrogation, no patients had recurrence of symptomatic ventricular arrhythmias.Conclusion Papillary muscles from both ventricles represent an anatomic structure potentially involved in the onset of VF, also in normal structural heart. PVCs arising from this area can be successfully eliminated by radiofrequency ablation, resulting in freedom from recurrent VF at long-term follow-up.
KW - PVC
KW - VF storm
KW - catheter ablation
KW - idiopathic ventricular fibrillation
KW - long term follow-up
KW - papillary muscle
KW - polymorphic ventricular tachycardia
KW - premature ventricular contraction
KW - sudden cardiac death
KW - ventricular fibrillation
UR - http://www.scopus.com/inward/record.url?scp=84912036022&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84912036022&partnerID=8YFLogxK
U2 - 10.1111/jce.12478
DO - 10.1111/jce.12478
M3 - Article
C2 - 24946987
AN - SCOPUS:84912036022
SN - 1045-3873
VL - 25
SP - 1158
EP - 1164
JO - Journal of cardiovascular electrophysiology
JF - Journal of cardiovascular electrophysiology
IS - 11
ER -