Open AccessA case of premature ventricular contractions originating from the papillary muscle in the right ventricle
Author(s) -
Senoo Keitaro,
Otsuka Takayuki,
Suzuki Shinya,
Sagara Koichi,
Yamashita Takeshi
Publication year - 2014
Publication title -
journal of arrhythmia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.463
H-Index - 21
eISSN - 1883-2148
pISSN - 1880-4276
DOI - 10.1016/j.joa.2013.08.002
Subject(s) - medicine , ventricle , cardiology , papillary muscle , qrs complex , intracardiac injection , catheter ablation , ablation , radiofrequency ablation , radiofrequency catheter ablation , anatomy
A 45‐year‐old man with premature ventricular contractions (PVCs) underwent electrophysiological studies. Activation mapping using a noncontact electroanatomical mapping system indicated that the septal mid‐apical region in the right ventricle was activated earliest. However, pace mapping did not match the activation mapping. Although the PVCs were successfully eliminated by applying radiofrequency current to the prepotential site preceding their QRS onset, a recurrence of PVCs with the same QRS morphology was observed at the 2‐month follow‐up examination, necessitating a second procedure. During the second procedure, echocardiography‐guided electroanatomic mapping revealed centrifugal activation from the right ventricular mid‐apical region on the septal portion of the anterior papillary muscle, but perfect pace mapping was not obtained at that site. With intracardiac echocardiography confirming good contact between the ablation catheter and papillary muscle, an irrigated radiofrequency current successfully eliminated the PVCs. This case indicates that the use of a guidance system may be feasible and useful for catheter ablation of PVCs originating from the right ventricular papillary muscle when there are discrepancies between activation mapping and pace mapping.