Overview
Papillary muscle ventricular arrhythmias (PM-VAs) are a type of arrhythmia originating from the papillary muscles of the heart. Catheter ablation is a therapeutic option for these arrhythmias, though historically it has been associated with unsatisfactory results.Diagnosis
Postero-medial papillary muscle is the most common origin of PM-VAs (60.8%), followed by antero-lateral (34.9%) and right ventricular papillary muscles (4.3%) 1.Management
Catheter ablation is an effective and safe strategy for PM-VAs 1.
The mean acute success rate of index ablation procedures is 88.1% 1.
Long-term success rate of catheter ablation is 69.2% 1.
Procedural complications are relatively low 1.
Use of intracardiac echocardiography (ICE), irrigated catheters, and catheters with continuous flow sensing (CFS) capability are associated with higher rates of long-term arrhythmia freedom 1.Key Recommendations
Catheter ablation is an effective and safe strategy for papillary muscle ventricular arrhythmias, with an acute success rate of 88.1% and a long-term success rate of 69.2% 1. (Evidence: Moderate)
The use of ICE, irrigated catheters, and catheters with CFS capability may be associated with higher rates of arrhythmia-freedom at long-term follow-up 1. (Evidence: Weak)References
1 Mariani MV, Piro A, Magnocavallo M, Chimenti C, Della Rocca D, Santangeli P et al.. Catheter ablation for papillary muscle arrhythmias: A systematic review. Pacing and clinical electrophysiology : PACE 2022. link