Advances in intracardiac imaging, mapping algorithms, and cryoablation have significantly improved the procedural success rates for ablating left ventricular papillary muscle arrhythmias.
] Papillary VA is the second rarest form of VA originating from the left ventricle. The posterior papillary muscle is a more common location of origin of ventricular ectopy than the anterior papillary muscle. Papillary VAs have been described in both structurally normal and abnormal hearts. The papillary muscles demonstrate unique anatomy among structures of the heart. They are among the thickest endocardial structures, and fibers on the papillary muscles have separations, likely contributing to anisotropy. e original description of posterior papillary VA named seven key features, including (1) normal baseline electrocardiogram (ECG); (2) VA with a pattern of right bundle branch block (RBBB) with superior axis; (3) an inability to induce VA with programmed stimulation; (4) an inabi lity to entrain; (5) inducibility with isoproterenol or epinephrine; (6) the earliest activation occurring in the papillary muscle; and (7) an absence of high-frequency potentials at the site of origin. 10 Several other clinical features were later described. Papillary VAs were observed to rarely cause sustained VT,
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Donnelly et al. (2018) conducted a review in Ventricular Arrhythmia Originating from the Left Ventricular Papillary Muscles. Catheter ablation was evaluated.
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