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 journalArticle

15 Citations (Scopus)

Abstract

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
Volume26
Issue number2
DOIs
StatePublished - Feb 1 2015

Fingerprint

Ventricular Premature Complexes
Papillary Muscles
Ventricular Tachycardia
Heart Ventricles
Cardiac Arrhythmias
Electrocardiography
Catheter Ablation
Phenylephrine
Isoproterenol
Adenosine
Echocardiography
Calcium
Muscles

Keywords

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Ventricular tachycardia originating from the septal papillary muscle of the right ventricle : Electrocardiographic and electrophysiological characteristics. / 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. 26, No. 2, 01.02.2015, p. 145-150.

Research output: Contribution to journalArticle

Santoro, Francesco ; Di Biase, Luigi ; Hranitzky, Patrick ; Sanchez, Javier E. ; Santangeli, Pasquale ; Perini, Alessandro Paoletti ; Burkhardt, John David ; Natale, Andrea. / Ventricular tachycardia originating from the septal papillary muscle of the right ventricle : Electrocardiographic and electrophysiological characteristics. In: Journal of Cardiovascular Electrophysiology. 2015 ; Vol. 26, No. 2. pp. 145-150.
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abstract = "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.",
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T2 - Electrocardiographic and electrophysiological characteristics

AU - Santoro, Francesco

AU - Di Biase, Luigi

AU - Hranitzky, Patrick

AU - Sanchez, Javier E.

AU - Santangeli, Pasquale

AU - Perini, Alessandro Paoletti

AU - Burkhardt, John David

AU - Natale, Andrea

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N2 - 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.

AB - 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.

KW - papillary muscle

KW - premature ventricular complexes

KW - radiofrequency ablation

KW - right ventricle

KW - ventricular arrhythmia

KW - ventricular tachycardia

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