Preferential Conduction During Posterior Papillary Muscle Origin Premature Ventricular Contractions Demonstrated by Pace Mapping

2016 ◽  
Vol 28 (2) ◽  
pp. 235-236 ◽  
Author(s):  
TAIHEI ITOH ◽  
TAKUMI YAMADA
Keyword(s):  
Papillary Muscle ◽  
Premature Ventricular Contractions ◽  
Posterior Papillary Muscle ◽  
Pace Mapping ◽  
Muscle Origin

scholarly journals Role of the notched unipolar electrogram in guiding catheter ablation of frequent premature ventricular contractions originating from the ventricular outflow tract

2020 ◽  
Vol 48 (12) ◽  
pp. 030006052097763
Author(s):  
Li-Hong Huang ◽  
Ming-Yang Gao ◽  
Li-Jun Zeng ◽  
Bo-Qia Xie ◽  
Liang Shi ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Ventricular Outflow Tract ◽  
Outflow Tract ◽  
Distribution Area ◽  
Premature Ventricular Contractions ◽  
Successful Ablation ◽  
Ablation Success ◽  
Pace Mapping ◽  
Unipolar Electrogram

Objective To investigate the value of a notched unipolar electrogram (N-uniEGM) in confirming the origin of premature ventricular contractions originating from the ventricular outflow tract (VOT-PVC) during mapping and ablation procedures. Methods This retrospective study enrolled consecutive patients with symptomatic idiopathic frequent VOT-PVCs that underwent radiofrequency ablation. The characteristics of the uniEGM of the successful ablation targets were analysed. N-uniEGM was defined as the uniEGM presenting a QS morphology with ≥1 steep notches on the downstroke deflection. All patients were followed-up for 3 months post-ablation. Results The study enrolled 190 patients with a mean ± SD age of 49.0 ± 15.3 years. N-uniEGMs were recorded in 124 of 190 (65.3%) patients. The N-uniEGM distribution area was limited to a mean ± SD of 0.8 ± 0.4 cm2. N-uniEGM showed consistency with the outcomes of activation mapping and pace mapping. Patients with an N-uniEGM had an ablation success rate of 98.4% (122 of 124) and their ablation times were significantly shorter than those without an N-uniEGM (7.6 ± 3.8 s versus 15.8 ± 8.8 s, respectively). The sensitivity and specificity of N-uniEGM in predicting successful ablation of VOT-PVCs were 72.6% and 91.7%, respectively. Conclusion N-uniEGM was a highly specific and moderately sensitive predictor of successful radiofrequency ablation in patients with VOT-PVCs.

P365Does papillary muscle ablation affect mitral valve function: a single centre experience

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
J Stassen ◽  
D Dilling ◽  
J Vijgen ◽  
J Schurmans ◽  
P Koopman
Keyword(s):  
Mitral Valve ◽  
Papillary Muscle ◽  
Delayed Enhancement ◽  
Papillary Muscles ◽  
Premature Ventricular Contractions ◽  
Valve Function ◽  
History Of ◽  
Study Population ◽  
The Impact

Abstract Introduction Ventricular arrhythmias from papillary muscles (PMs) often require extensive catheter ablation (CA). Not much is known about the mitral valve (MV) function after these extensive catheter ablations. Purpose The goal of this study was to determine the impact of papillary muscle CA on MV function.  Methods We retrospectively examined echocardiographic measurements in 21 patients with frequent premature ventricular contractions (PVCs) originating from the mitral PMs who underwent CA, dating from October 2012 till November 2018. We assessed MV function at baseline, 6 month and last follow-up. Degree of mitral regurgitation (MR) was graded as mild (ERO <0,2 cm2, regurgitation volume (RV) <30ml), moderate (ERO 0,2-0,4cm2, RV 30-59ml) or severe (ERO ≥0,4cm2, RV  ≥60ml). Significant MR was defined as a 2+ change. Results Mean age of the study population was 59,7 (27-80)years, 52,4% was female. 2 patients were known with ischemic heart disease. There was a family history of sudden cardiac death in 3 patients. Main symptoms at presentation were palpitations (66,7%), fatigue (33,3%), dyspnea (33,3%, all NYHA 2), dizziness (28,6%), angina pectoris (14,3%) and syncope (4,8%). Beta blocker (71,4%), flecaïnide (23,8%), amiodarone (9,5%), sotalol (4,8%) and propafenon (4,8%) were the most frequent medical therapies before CA. Mean burden of PVC before ablation was 15 574 (2000-39700)/24h. In 28,6% non sustained VT was documented, 1 patient suffered a sustained episode of VT.  After ablation, mean burden of PVC was reduced to 1331 (0-14200)/24h. Redo ablation was necessary in 28,6% of patients. PVCs orginated from the anterolateral PM in 33,3% and from the posteromedial PM in 66,7%. Mean troponin release was 9.4 ± 5.3 µg/l, mean troponin hs (since 2016) was 1591.0 ±658.6ng/ml. CMR was done in 14/21 (66,7%) patients before CA. In 5 out of 14 patients (35,7%), delayed enhancement at the papillary muscles was noticed. In 5 patients without delayed enhancement, CMR was repeated after CA. In all these 5 patients, delayed enhancement was noticed at the level of the papillary muscles.  At baseline, 15/21 had mild, 5/21 moderate and  1/21 severe MR. There was no significant chance in MR at 6m follow-up with 15/21 having mild and  6/21 moderate MR (p 0.58) with 1 patient having a significant MR 2+ change. At last follow-up (23.7 ± 22.6 months) there was also no significant chance in MR with 15/21 having mild and 6/21 moderate MR (p 0.58) without a significant MR 2+ change.  Complications occurred in 1 patient (transient AV blok). No patients died during follow up.  Conclusions Although PM ablation was associated with time extensive ablation, significant troponine release and documented delayed enhancement on post ablation MRI, there was no risk of additional valvular dysfunction after CA in this study. Larger studies will be necessary to confirm these findings.

POSTERIOR MITRAL REGURGITATION IN GIRLS POSSIBLY DUE TO POSTERIOR PAPILLARY MUSCLE DYSFUNCTION

PEDIATRICS ◽  
1968 ◽  
Vol 42 (2) ◽  
pp. 276-290
Author(s):  
V. V. Sreenivasan ◽  
Jerome Liebman ◽  
Donald S. Linton ◽  
Thomas D. Downs
Keyword(s):  
Mitral Regurgitation ◽  
Papillary Muscle ◽  
Functional Anatomy ◽  
Muscle Dysfunction ◽  
Posterior Leaflet ◽  
T Wave ◽  
Posterior Papillary Muscle ◽  
Angular Analysis ◽  
Papillary Muscle Dysfunction

Nine girls are presented with variable late systolic murmurs (usually best heard sitting up); five of the nine had mid systolic clicks, minimal to mild mitral regurgitation, and striking variable primary electrocardiographic T wave abnormalities. Data from a tenth girl, who has not yet had cardiac catheterization, with similar clinical features are included. The functional anatomy of the mitral valve and some of the factors that give rise to such a picture are discussed. A detailed cineangiographic analysis of the mitral regurgitation is made with stress on the role of the posterior leaflet and posterior papillary muscle. A quantitative angular analysis of the T waves is made. The vectorcardiogram's superiority to the standard electrogram is made clear in this regard. We believe that this syndrome is caused by posterior papillary muscle dysfunction, though the etiology, including the reason why only girls should be affected, is not known. The prognosis is believed to be good.

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