Ventricular Tachycardia Originating From the Posterior Papillary Muscle in the Left Ventricle A Distinct Clinical Syndrome

Background-Several distinct forms of focal ventricular tachycardia (VT) front the left ventricle (LV) have been described. We report a new syndrome of VT arising from the base of the posterior papillary Muscle ill the LV. Methods and Results-Among 290 consecutive patients who underwent ablation for VT or symptomatic premature ventricular complexes (PVCs) based oil a focal mechanism, 7 patients were found to have all ablation site at the base of the posterior papillary Muscle in the LV. All patients had normal LV systolic function and it normal baseline electrocardiogram. The electrocardiogram during VT or PVCs demonstrated it right bundle-branch block and superior-axis QRS morphology in all patients. VT was not inducible by programmed atrial or ventricular stimulation. In 2 patients with sustained VT. overdrive pacing neither terminated VT nor demonstrated any criterion for transient entrainment. Activation mapping localized the earliest site of activation to the base of the posterior papillary Muscle in all patients. When Purkinje potentials were recorded at the site of Successful ablation, these potentials preceded local ventricular Muscle potentials during sinus rhythm. During VT or PVCs. however, the ventricular Muscle potential always preceded the Purkinje potentials. After recurrence of VT or PVCs with standard radiofrequency ablation. irrigated ablation was successful in eliminating the arrhythmia in all patients. Over a mean follow-up period of 9 months. all patients have been free of PVCs and VT. Conclusion-We present a distinct syndrome of VT arising from the base of the posterior papillary muscle in the LV by if nonreentrant mechanism. Ablation call be challenging, and irrigated ablation may be necessary for long-term Success. (Circ Arrhythmia Electrophysiol. 2008;1:23-29.)