Multipolar mapping for catheter ablation of premature ventricular complexes originating from papillary muscles in the structurally normal heart: a case series

Figures

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  Fig. 1. Twelve-lead electrocardiograms exhibiting PVCs arising from the APM and PPM. In patient 3 and 6, the PVCs have an RBBB pattern and right inferior axis, suggesting an origin at the APM. In patients 1, 2, 4 and 5, the PVCs morphology corresponds to an RBBB pattern and left superior axis, suggesting an origin at the PPM. PVCs, premature ventricular complexes; APM, anterolateral papillary muscle; PPM, posteromedial papillary muscle; RBBB, right bundle branch block

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  Fig. 2. Multipolar mapping of the APM with the linear duodecapolar catheter in patient 3. a, b High-density mapping of left ventricle using the linear duodecapolar catheter showed the site of earliest ventricular activation during clinical PVCs was located at the APM, which was marked with the red dot. c Intracardiac electrogram during PVCs demonstrated the earliest ventricular potential recorded at DD 1–2 (54 ms pre-QRS), and they conducted upward along the linear catheter. d Pacing from a site with earliest ventricular activation seen on DD 1–2 revealed a perfect pace map match. e Radiofrequency energy was delivered to the target site of the red dot with 52 ms pre-QRS and PVCs terminated following transient monomorphic non-sustained ventricular tachycardia. DD, duodecapolar catheter. Other abbreviations as in Fig. 1

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  Fig. 3. Multipolar mapping of the PPM with the linear duodecapolar catheter in patient 5. a, b A 3-dimensional ventricular activation map during clinical PVCs guided by the linear duodecapolar catheter showed ventricular excitation sites in the PPM of the left ventricle. The red dot indicated the site where the earliest ventricular excitation potential was recorded during PVCs. The yellow dots on the proximal duodecapolar catheter indicated the His-bundle site. c Intracardiac electrogram recorded with a duodecapolar catheter during the PVCs (left panel) showed the earliest local ventricular potential preceding the QRS onset by 42 ms located at DD 9–10 (asterisk), and they conducted upward and downward along the linear catheter, respectively. During the sinus beat (right panel), the proximal DD 19–20 and DD 18–19 (red arrow) recorded his bundle potentials. d Pacing from a site with earliest ventricular activation seen on DD 9–10 demonstrated a good pace map match. E. We delivered radiofrequency energy to the target site of the red dot with 38 ms pre-QRS and terminated PVCs. Abbreviations as in Fig. 1 and 2