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Papillary muscle disorder — Clinical Guidelines

Overview

Papillary muscle disorders involve abnormal electrical activity or structural abnormalities affecting the papillary muscles, often leading to ventricular arrhythmias. Catheter ablation has been explored as a treatment modality with varying outcomes. 1

Diagnosis

Electrocardiogram (ECG) abnormalities indicative of ventricular arrhythmias.

Electrophysiology studies to localize the origin of arrhythmias in papillary muscles.

Imaging techniques (echocardiography) to assess structural abnormalities. 1

Management

First-line: Catheter ablation targeting the arrhythmogenic focus in papillary muscles. 1

Adjunctive: Antiarrhythmic medications (specific drug classes and doses not detailed in provided abstracts).

Special Populations

Pediatrics: Sedation monitoring using Comfort Score and Bispectral Index (BIS) during invasive procedures like muscle biopsy may be relevant for assessing procedural safety and comfort, though not directly related to papillary muscle disorders. 2

Elderly and Comorbidities: Specific considerations not addressed in the provided abstracts.

Key Recommendations

Catheter ablation can be considered for treating papillary muscle ventricular arrhythmias, though efficacy and safety profiles require further investigation due to mixed outcomes reported. (Evidence: Moderate 1)

For pediatric patients undergoing procedures potentially affecting muscle tissue, BIS monitoring alongside Comfort Score enhances sedation assessment. (Evidence: Moderate 2)

Further research is needed to standardize diagnostic criteria and procedural techniques for optimal management of papillary muscle disorders. (Evidence: Expert opinion)

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 2 Tschiedel E, Müller O, Schara U, Felderhoff-Müser U, Dohna-Schwake C. Sedation monitoring during open muscle biopsy in children by Comfort Score and Bispectral Index - a prospective analysis. Paediatric anaesthesia 2015. link 3 Cirielli C, Serino F, Straino S, Toietta G, Abeni D, Ventoruzzo G et al.. Adenovirus vectors targeting alphaV integrin or heparan sulfate receptors display different distribution of transgene activity after intramuscular injection. The journal of gene medicine 2004. link 4 Ma J. Block by ruthenium red of the ryanodine-activated calcium release channel of skeletal muscle. The Journal of general physiology 1993. link 5 Hieu LH, Nemcsók J, Molnár E, Dux L. Different sensitivity of the sarcoplasmic reticulum Ca(2+)-ATPase enzyme to fluorescein-isothiocyanate in rabbit and carp muscles. Comparative biochemistry and physiology. B, Comparative biochemistry 1992. link90266-t) 6 Briggs MM, Lin JJ, Schachat FH. The extent of amino-terminal heterogeneity in rabbit fast skeletal muscle troponin T. Journal of muscle research and cell motility 1987. link 7 Stauber WT, Fritz VK, Dahlmann B, Kay J, Heath R, Mayer M. Alkaline proteinase localization in myoblasts. The journal of histochemistry and cytochemistry : official journal of the Histochemistry Society 1987. link 8 Malouf NN, Taylor S, Gillespie GY, Bynum JM, Wilson PE, Meissner G. Monoclonal antibody specific for the T-tubule of skeletal muscle. The journal of histochemistry and cytochemistry : official journal of the Histochemistry Society 1986. link 9 Penny IF, Taylor MA, Harris AG, Etherington DJ. Purification and immunological characterisation of two calcium-activated neutral proteinases from rabbit skeletal muscle. Biochimica et biophysica acta 1985. link90194-3) 10 Ngai PK, Walsh MP. Detection of caldesmon in muscle and non-muscle tissues of the chicken using polyclonal antibodies. Biochemical and biophysical research communications 1985. link80192-3) 11 Bird IM, Dhoot GK, Wilkinson JM. Identification of multiple variants of fast muscle troponin T in the chicken using monoclonal antibodies. European journal of biochemistry 1985. link 12 Watabe S, Dinh TN, Ochiai Y, Hashimoto K. Immunochemical specificity of myosin light chains from mackerel ordinary and dark muscles. Journal of biochemistry 1983. link 13 Merrifield PA, Payne MR, Konigsberg IR. Isoform specificity of monoclonal hybridoma antibodies to quail skeletal muscle myosin subunits. Biochemical and biophysical research communications 1983. link91741-2) 14 Kobayashi R, Itoh H, Tashima Y. Polymorphism of alpha-actinin. Electrophoretic and immunological studies of rabbit skeletal muscle alpha-actinins. European journal of biochemistry 1983. link 15 Carpenè E, Rowlerson A, Veggetti A, Mascarello F. Preparation of type-specific antimyosin antibodies and determination of their specificity by biochemical and immunohistochemical methods. The Italian journal of biochemistry 1982. link 16 Atassi MZ. Reaction of myoglobin with 3,3-tetramethyleneglutaric anhydride. The Biochemical journal 1967. link

Papillary muscle disorder