Ventricular fibrillation induced by a radiofrequency energy delivery for idiopathic premature ventricular contractions arising from the left ventricular anterior papillary muscle.
A 73-year-old man with idiopathic premature ventricular contractions (PVCs) underwent electrophysiological testing. Left ventricular activation mapping revealed a focal mechanism of the PVCs with the earliest activation on the anterior papillary muscle (APM). Irrigated radiofrequency (RF) current delivered at that site induced a cluster of non-sustained ventricular tachycardia episodes with the same QRS morphology as the PVCs, followed by ventricular fibrillation (VF). The APM might have served as an abnormal automatic trigger and driver for the VF occurrence. Ventricular fibrillation may occur as a complication during RF catheter ablation of papillary muscle ventricular arrhythmias even if the clinical arrhythmia is limited to PVCs.
Yamada
Takumi
T
Division of Cardiovascular Disease, University of Alabama at Birmingham, VH B147, 1670 University Boulevard, 1530 3rd AVE S, Birmingham, AL 35294-0019, USA. takumi-y@fb4.so-net.ne.jp
McElderry
H Thomas
HT
Allred
James D
JD
Doppalapudi
Harish
H
Kay
G Neal
GN
D000368:Aged; D017115:Catheter Ablation / Q000009:adverse effects*; D006329:Heart Conduction System / Q000002:abnormalities* / Q000601:surgery*; D006352:Heart Ventricles / Q000002:abnormalities / Q000601:surgery; D006801:Humans; D008297:Male; D010210:Papillary Muscles / Q000002:abnormalities* / Q000601:surgery*; D014693:Ventricular Fibrillation / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D018879:Ventricular Premature Complexes / Q000601:surgery*