Ventricular fibrillation triggered by PVCs from papillary muscles

Clinical features and ablation

Francesco Santoro, Luigi Di Biase, Patrick Hranitzky, Javier E. Sanchez, Pasquale Santangeli, Alessandro Paoletti Perini, John David Burkhardt, Andrea Natale

Research output: Contribution to journalArticle

44 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1158-1164
Number of pages7
JournalJournal of Cardiovascular Electrophysiology
Volume25
Issue number11
DOIs
StatePublished - Nov 1 2014

Fingerprint

Ventricular Premature Complexes
Papillary Muscles
Ventricular Fibrillation
Heart Ventricles
Ambulatory Monitoring
Defibrillators
Catheter Ablation
Implantable Defibrillators
Anti-Arrhythmia Agents
Cardiomyopathies
Myocardial Ischemia
Cardiac Arrhythmias
Shock
Safety
Recurrence
Drug Therapy

Keywords

  • catheter ablation
  • idiopathic ventricular fibrillation
  • long term follow-up
  • papillary muscle
  • polymorphic ventricular tachycardia
  • premature ventricular contraction
  • PVC
  • sudden cardiac death
  • ventricular fibrillation
  • VF storm

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)
  • Medicine(all)

Cite this

Ventricular fibrillation triggered by PVCs from papillary muscles : Clinical features and ablation. / Santoro, Francesco; Di Biase, Luigi; Hranitzky, Patrick; Sanchez, Javier E.; Santangeli, Pasquale; Perini, Alessandro Paoletti; Burkhardt, John David; Natale, Andrea.

In: Journal of Cardiovascular Electrophysiology, Vol. 25, No. 11, 01.11.2014, p. 1158-1164.

Research output: Contribution to journalArticle

Santoro, F, Di Biase, L, Hranitzky, P, Sanchez, JE, Santangeli, P, Perini, AP, Burkhardt, JD & Natale, A 2014, 'Ventricular fibrillation triggered by PVCs from papillary muscles: Clinical features and ablation', Journal of Cardiovascular Electrophysiology, vol. 25, no. 11, pp. 1158-1164. https://doi.org/10.1111/jce.12478
Santoro, Francesco ; Di Biase, Luigi ; Hranitzky, Patrick ; Sanchez, Javier E. ; Santangeli, Pasquale ; Perini, Alessandro Paoletti ; Burkhardt, John David ; Natale, Andrea. / Ventricular fibrillation triggered by PVCs from papillary muscles : Clinical features and ablation. In: Journal of Cardiovascular Electrophysiology. 2014 ; Vol. 25, No. 11. pp. 1158-1164.
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abstract = "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.",
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AU - Santoro, Francesco

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AU - Sanchez, Javier E.

AU - Santangeli, Pasquale

AU - Perini, Alessandro Paoletti

AU - Burkhardt, John David

AU - Natale, Andrea

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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.

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KW - sudden cardiac death

KW - ventricular fibrillation

KW - VF storm

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