Ventricular tachycardia originating from the septal papillary muscle of the right ventricle: Electrocardiographic and electrophysiological characteristics

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

Research output: Contribution to journalArticlepeer-review

30 Scopus citations


RV Septal Papillary Muscle VT Introduction Premature ventricular complexes (PVCs) and ventricular tachycardia (VT) arising from papillary muscles of both ventricles have recently been described. There is a lack of data on VT originating from the right ventricular papillary (RV PAP) muscles. There have been no prior studies focused on the electrocardiogram (ECG) features and ablation of PVC/VT arising from the septal papillary muscle of the right ventricle. Methods Among 155 consecutive patients with normal structural heart who underwent catheter ablation of PVC/VT, 8 patients with PVC/VT from the septal RV PAP muscle were identified. The site of origin of the arrhythmias was identified through activation/pace mapping and intracardiac echocardiography. All patients underwent radiofrequency ablation of the arrhythmia. Results Data on 8 consecutive patients (2 men, age 42 ± 13 years old) were collected. All patients had a preserved ejection fraction (60 ± 4%). Septal RV PAP arrhythmias had a left superior axis and negative concordance or late R-wave transition in precordial leads. PVCs were spontaneous in 5 cases, were induced by isoprotenerol in 2 cases and by isoproterenol plus phenylephrine in another one. PVCs were never induced with calcium bolus and only rarely with burst pacing. Adenosine never terminated VT or suppressed the VT/PVCs. Radiofrequency, fluoroscopic, and procedural time were, respectively, 10.3 ± 3, 36.4 ±11.3, and 76.3 ± 27.5 minutes. During a mean follow-up of 8 ± 4 months, mean PVC burden was reduced from 14 ± 3% preablation to 0.1 ± 0.2% postablation. Conclusion PVCs and VT originating from septal RV papillary muscle could have a typical ECG pattern due to the site of the muscle involved. Radiofrequency ablation of this anatomic area is feasible and effective.

Original languageEnglish (US)
Pages (from-to)145-150
Number of pages6
JournalJournal of cardiovascular electrophysiology
Issue number2
StatePublished - Feb 1 2015


  • papillary muscle
  • premature ventricular complexes
  • radiofrequency ablation
  • right ventricle
  • ventricular arrhythmia
  • ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)


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