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How to map and ablate papillary muscle ventricular arrhythmias

      The papillary muscles (PMs) are a source of ventricular arrhythmias (VAs) in both structurally normal and abnormal hearts. Presentation includes isolated premature ventricular contractions (PVCs), nonsustained ventricular tachycardia (VT), and sustained recurrent VT. In addition, PVCs arising from the PMs may play a role as triggers of ventricular fibrillation (VF).
      • Van Herendael H.
      • Zado E.S.
      • Haqqani H.
      • et al.
      Catheter ablation of ventricular fibrillation: importance of left ventricular outflow tract and papillary muscle triggers.
      • Santoro F.
      • Di Biase L.
      • Hranitzky P.
      • Sanchez J.E.
      • Santangeli P.
      • Perini A.P.
      • Burkhardt J.D.
      • Natale A.
      Ventricular fibrillation triggered by PVCs from papillary muscles: clinical features and ablation.
      Because of their highly variable and complex anatomy and independent motion during the cardiac cycle, catheter ablation is challenging, with lower procedural success and higher recurrence rates compared with other locations.
      • Latchamsetty R.Y.
      • Yokokawa M.
      • Morady F.
      • et al.
      Multicenter outcomes for catheter ablation of idiopathic premature ventricular complexes.
      In this review, we present our practical approach to mapping and ablation of PM VAs.

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