CLINICAL RESEARCH: HEART RHYTHM DISORDER
Post-Infarction Ventricular Arrhythmias Originating in Papillary Muscles
Frank Bogun, MD*,
Benoit Desjardins, MD,
Thomas Crawford, MD,
Eric Good, DO,
Krit Jongnarangsin, MD,
Hakan Oral, MD,
Aman Chugh, MD,
Frank Pelosi, MD and
Fred Morady, MD
University of Michigan Medical Center, Ann Arbor, Michigan.
Manuscript received August 2, 2007;
revised manuscript received January 23, 2008,
accepted January 27, 2008.
* Reprint requests and correspondence: Dr. Frank Bogun, Assistant Professor of Medicine, Division of Cardiology, CVC Cardiovascular Medicine, 1500 East Medical Center Drive SPC 5853, Ann Arbor, Michigan 48109-5853. (Email: fbogun{at}med.umich.edu).
Objectives: The aim of this study was to define the role of papillary muscles (PAPs) in post-infarction ventricular arrhythmias.
Background: Papillary muscles have been implicated in arrhythmogenesis; however, their role in post-infarction ventricular arrhythmias has not been well-defined.
Methods: In a series of 9 patients (age 65 ± 9 years, ejection fraction 0.36 ± 0.1) with post-infarction ventricular arrhythmias, electroanatomic mapping in conjunction with intracardiac echocardiography demonstrated that 1 of the PAPs was involved in the arrhythmia. Magnetic resonance imaging with delayed enhancement (DEMRI) was performed in all patients without contraindications. A consecutive series of 9 patients (age 64 ± 8 years, ejection fraction 0.32 ± 0.14) with ventricular arrhythmias that did not originate from the PAP served as a control group and also underwent DEMRI.
Results: Heterogeneous uptake of gadolinium during magnetic resonance imaging was observed more frequently in arrhythmogenic PAPs than in PAPs that were not involved in ventricular arrhythmias (p = 0.01). The PAPs in the control patients did not take up contrast or show homogeneous contrast uptake. Radiofrequency ablation eliminated all arrhythmias originating from PAPs. Echocardiography after the ablation showed no new or worsened mitral regurgitation.
Conclusions: Papillary muscles that lie within an infarct zone might give rise to ventricular arrhythmias. Heterogeneous uptake of gadolinium in magnetic resonance images might be predictive of arrhythmogenic PAPs. Radiofrequency catheter ablation of ventricular tachycardia and ventricular ectopy arising in a PAP has a high success rate.
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Abbreviations and Acronyms
| | DEMRI = magnetic resonance imaging with delayed enhancement | | ICD = implantable cardioverter-defibrillator | | MRI = magnetic resonance imaging | | PAP = papillary muscle | | PVC = premature ventricular complex | | VT = ventricular tachycardia |
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