Catheter ablation of papillary muscle arrhythmias: Implications of mitral valve prolapse and systolic dysfunction

2018 ◽  
Vol 41 (7) ◽  
pp. 750-758 ◽  
Author(s):  
Adam Lee ◽  
Christian Hamilton‐Craig ◽  
Russell Denman ◽  
Haris M. Haqqani
Keyword(s):  
Catheter Ablation ◽  
Mitral Valve ◽  
Papillary Muscle ◽  
Mitral Valve Prolapse ◽  
Systolic Dysfunction

scholarly journals P436Abnormal papillary muscle signal on cine CMR images in mitral valve prolapse

2019 ◽  
Vol 20 (Supplement_2) ◽  
Author(s):  
A Scatteia ◽  
C E Pascale ◽  
P Guarini ◽  
S Dellegrottaglie
Keyword(s):  
Mitral Valve ◽  
Papillary Muscle ◽  
Mitral Valve Prolapse ◽  
Cine Cmr

Excessive Papillary Muscle Traction and Dilated Mitral Annulus in Mitral Valve Prolapse Without Mitral Regurgitation

1996 ◽  
Vol 78 (4) ◽  
pp. 482-485 ◽  
Author(s):  
Tsung-Ming Lee ◽  
Sheng-Fang Su ◽  
Tsuei-Yuen Huang ◽  
Ming-Fong Chen ◽  
Chiau-Suong Liau ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Papillary Muscle ◽  
Mitral Valve Prolapse ◽  
Mitral Annulus

Papillary muscle ventricular arrhythmias among patients with mitral valve prolapse

2018 ◽  
Vol 29 (5) ◽  
pp. E6-E6
Author(s):  
Brian L. Fulton ◽  
Jackson J. Liang ◽  
Andres Enriquez ◽  
Yuchi Han
Keyword(s):  
Mitral Valve ◽  
Papillary Muscle ◽  
Mitral Valve Prolapse ◽  
Ventricular Arrhythmias

Abstract 20364: Successful Ablation of Ventricular Fibrillation in Malignant Bileaflet Mitral Valve Prolapse Syndrome

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Faisal F Syed ◽  
Peter Noseworthy ◽  
Christopher McLeod ◽  
Suraj Kapa ◽  
Siva Mulpuru ◽  
...  
Keyword(s):  
Ventricular Fibrillation ◽  
Mitral Valve ◽  
Papillary Muscle ◽  
Mitral Valve Prolapse ◽  
Left Ventricular ◽  
Beta Blockade ◽  
Successful Ablation ◽  
Procedural Success ◽  
Variable Coupling

Introduction: Although the vast majority of mitral valve prolapse (MVP) is benign, women with bileaflet MVP (biMVP), complex ventricular ectopy (VE), and abnormal T waves may comprise the recently described malignant biMVP syndrome. The mechanism of ventricular arrhythmia is unknown. To further characterize the arrhythmic substrate, we reviewed our center’s ablation experience in 6 biMVP patients with prior cardiac arrest and recurrent ICD shocks for drug refractory ventricular fibrillation (VF). Methods and Results: Six women with biMVP (median age 31.5 [range 24.2 - 58.7] years, EF 65 [45 - 67]%, all ≤moderate mitral regurgitation) experienced 6 (3 - 25) appropriate ICD shocks over 4.8 (2.8 - 10.7) years and underwent index ablation between 2/2007 - 10/2013. All had multiple VE morphologies (median 7 [3 - 24]) with variable coupling intervals but with a predominant VE trigger for the VF. A median 2 (1 - 4) VE foci were ablated. Sites of successful ablation of VF-triggering and other dominant VE were left ventricular papillary muscles [PM] (1 anterior, 1 posterior, 1 both), fascicles (1 anterior, 1 posterior), or both (1 both PM and posterior fascicle). Outflow tract VE was also present and targeted (1 left, 1 right)i. Two underwent repeat ablation (288 and 312 days) for recurrent complex VE without shocks, with different foci to the index ablation (1 posterior fascicle, 1 both fascicles). The VF-triggering VE in all patients was confirmed as originating from within the left fascicular system, which in 3/6 was at a papillary muscle. Acute procedural success was seen in all with no complications to date. A VF storm occurred within 24 hours of ablation in a single patient. At follow-up of a mean 662 (47 - 2099) days, 1 patient received a single shock (p=0.03 vs. preablation). Symptomatic VE was reduced in all; while 3/6 continue Class 1c antiarrhythmics and 5/6 have beta blockade. Conclusion: Malignant biMVP syndrome is characterized by fascicular and papillary muscle PVCs that trigger ventricular fibrillation, yet in all patients, the VE is multifocal. Ablation of at least one focus appears to improve symptoms and reduce shocks.

Imaging characteristics of papillary muscle site of origin of ventricular arrhythmias in patients with mitral valve prolapse

2017 ◽  
Vol 29 (1) ◽  
pp. 146-153 ◽  
Author(s):  
Brian L. Fulton ◽  
Jackson J. Liang ◽  
Andres Enriquez ◽  
Fermin C. Garcia ◽  
Gregory E. Supple ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Papillary Muscle ◽  
Mitral Valve Prolapse ◽  
Ventricular Arrhythmias ◽  
Imaging Characteristics

scholarly journals P1689 Mitral valve prolapse secondary to ischemic cardiomyopathy

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
G Babur Guler ◽  
A Kilicgedik ◽  
H Zencirkiran Agus ◽  
G Kahveci
Keyword(s):  
Myocardial Infarction ◽  
Mitral Valve ◽  
Left Ventricle ◽  
Mitral Regurgitation ◽  
Transesophageal Echocardiography ◽  
Papillary Muscle ◽  
Mitral Valve Prolapse ◽  
Systolic Function ◽  
Systolic Pulmonary Artery Pressure ◽  
Mitral Prolapse

Abstract Introduction Mitral valve prolapse is the most common form of degenerative mitral valve disease. However, ischemic mitral valve prolapse is a rare cause of mitral regurgitation. The mechanism was initially thought to be papillary muscle dysfunction, but more complex mechanisms were suggested recently. Purpose Try to understand the pathophysiology of ischemic mitral valve prolapse on a case example. Case Report A 42-year-old male with a history of inferoposterior myocardial infarction was admitted from outpatient clinic due to NYHA class 3 heart failure symptoms. On physical examination, a 4/6 holosystolic murmur was heard in the apex. He had a permanent pacemaker implanted for sick sinus syndrome. Transthoracic echocardiography showed 1-global dysfunction of the left ventricle (posterior segment akinetic and thinned), 2- prolapse of the posterior mitral leaflet (suspicion of ruptured chordae) 3-severe mitral regurgitation (with anterior eccentric jet), 4- moderate tricuspid regurgitation and high systolic pulmonary artery pressure (65 mmHg), 5- pacemaker lead in the right heart chambers. 6- normal right ventricular systolic function. Transesophageal echocardiography showed P2 scallop prolapse and chordae were intact, there were no redundant or myxamous components of the leaflets. It was observed that the posteromedial papillary muscle was elongated and did not contract. We commented that these echocardiographic findings represented ischemic mitral valve prolapse. Other echo findings in favour of this hypothesis were the posteromedial papillary muscle prolongation in systole and reduced the free strain of papillary muscle in the the apical long axis view. The patient underwent mitral ring anuloplasty and surgical neocord implantation. Surgery also reported the aetiology as ischemic mitral prolapse secondary to chordal extension in accordance with echocardiography. Conclusion(s): Ischemic mitral prolapse is a complex pathology involving multiple components of the mitral valve apparatus as left ventricle, papillary muscle, chordae, annulus, leaflets. The diagnostic criteria for ischemic mitral valve prolapse and its management are not defined. The presence of myocardial infarction and the exclusion of other possible valve pathologies with transesophageal echocardiography are important steps in the diagnosis. Abstract P1689 Figure.

P6490Paradoxycal restricted motion in diastole is a frequent finding in mitral valve prolapse/dystrophy patients

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Le Tourneau ◽  
C Cueff ◽  
N Piriou ◽  
R Capoulade ◽  
S Le Scouarnec ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Aortic Valve ◽  
Clinical Examination ◽  
Papillary Muscle ◽  
Mitral Valve Prolapse ◽  
Mitral Annulus ◽  
Filamin A ◽  
Familial Form ◽  
Frequent Finding ◽  
Valve Annulus

Abstract Background Filamin-A mitral valve prolapse/dystrophy (FLNA-MVP) phenotype associates MVP and a paradoxical restricted motion in diastole. Purpose We aim to assess the association of mitral valve prolapse to restricted motion in diastole in MVP patients (restricted MVP). Methods We prospectively enrolled 475 MVP probands (64±13 years) and controls relatives. Patients underwent a clinical examination and a comprehensive echocardiographic analysis of mitral valve apparatus. Results Among 475 consecutive probands, 48 (10.1%, 95% CI 7.7–13.3) had both a MVP and a doming aspect in diastole. Patients with restricted MVP exhibited shorted chordae tendinaes, and a shorter distance between papillary muscle tip and mitral annulus. Compared with controls, mitral valve leaflets were lenghtened, thickened and mitral valve annulus was enlarged. The prevalence of polyvalvular disease and bicuspid aortic valve was not increased in restricted MVP patients compared with conventional MVP. Familial form of restricted MVP was identified even in the absence of Filamin-A mutation. Conclusion Restricted MVP is a quite frequent finding in MVP patients and is associated with unique features of the MV apparatus. Restricted MVP can be regarded as a third type of MVP beside myxomatous Barlow disease and fibro-elastic deficiency MVP. Acknowledgement/Funding PHRC I Mitral, Fédération Française de Cardiologie, Fondation Coeur et recherche

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