Key result
Pulsed field ablation successfully suppresses posteromedial papillary muscle PVCs, reducing burden to <1%.
Why the study?
Catheter ablation of ventricular arrhythmias originating from left ventricular papillary muscles remains challenging with lower success rates compared with ventricular outflow tract arrhythmias.
Case Report (n=1)
No
Pulse field ablation can be a safe and effective modality for the suppression of challenging premature ventricular complexes originating from the papillary muscles, overcoming limitations of traditional radiofrequency ablation.
May support pulse field ablation for papillary muscle premature ventricular complexes; hypothesis-generating and requires prospective validation before practice change.
The left ventricular papillary muscles (PMs) are intracavitary structures that can be the source of ventricular arrhythmias in patients with and without structural heart disease.1 Catheter ablation can be very effective and safe for treating these arrhythmias; however, success rates have been reported to be lower compared with arrhythmias originating from the ventricular outflow tracts.1,2 Complex anatomy, variable site of origin and exit site, inadequate catheter stability, and contact force are among the reasons why ablating arrhythmias from the PMs can be challenging despite the use of contact force–sensing catheters and intracardiac echocardiography (ICE).
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Vasquez et al. (2025) conducted a case report in Premature ventricular complexes arising from the posteromedial papillary muscle (n=1). Pulse Field Ablation (PFA) was evaluated on Premature ventricular complex (PVC) suppression. Pulse field ablation successfully suppressed premature ventricular complexes arising from the posteromedial papillary muscle, reducing burden to <1% and improving left ventricular systolic function.
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