Key result
Precise mapping with intracardiac echocardiography is required to ablate complex conduction system and papillary muscle arrhythmias.
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Detailed electrophysiological mapping and adjunctive tools like intracardiac echocardiography are essential for the successful catheter ablation of complex fascicular and papillary muscle arrhythmias.
Arrhythmias originating from the specialised cardiac conduction system and papillary muscles can occur in both structurally normal and diseased hearts. Conduction system associated arrhythmias include bundle branch re-entry, fascicular re-entry, non-re-entrant fascicular ventricular tachycardia and idiopathic ventricular fibrillation. Each type of arrhythmia requires a unique diagnostic and therapeutic approach. The papillary muscles may also be a source of ventricular arrhythmias. Ablation of papillary muscle associated arrhythmias may be difficult due to the complexities of mapping, structural abnormalities and potentially the deep location of arrhythmia foci. Tools, such as intracardiac echocardiography, can be valuable.
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Richardson et al. (2025) conducted a review in Fascicular and Papillary Muscle Arrhythmias. Catheter ablation was evaluated. Catheter ablation of conduction system and papillary muscle arrhythmias requires precise mapping techniques, such as intracardiac echocardiography, to overcome structural complexities.
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