Catheter ablation of ventricular arrhythmias originating from right ventricular posterior papillary muscle-false tendon complexZhang et al. Right ventricular posterior papillary muscle-false tendon complex

Background and aims Posterior papillary muscle (PPM) and false tendons (FTs) in the right ventricle (RV) may act as a potential source of ventricular arrhythmias(VAs). We aimed to systematically describe the electrophysiological characteristics and the outcome of radiofrequency catheter ablation (RFCA) of VAs originating from the RV PPM -FT complex. Methods From a total of 2184 patients with VAs who underwent catheter ablation, 12 patients (0.55%) with VAs associated with RV PPM-FTs complex were enrolled in the study. Activation mapping and pace mapping were performed to localize the origin of VAs. Intracardiac echocardiography (ICE) was used in all patients to directly visualize the PPM and the FTs. We chose 12 patients with VAs originating from the RV moderate band (MB) as the control group. Conclusions In contrast to the MB group, the QRS duration, the R wave duration and the RS interval of lead V1 of the study group was longer. The negative component in inferior leads (II, III, aVF) of the study group was deeper than the MB group. The PVCs in the study group were successfully eliminated by ablation in all patients. The target sites were confirmed to be related to the RV PPM and FTs complex. A pre-systolic potential was observed preceding local ventricular activation in seven patients.