Catheter Ablation on Papillary Muscle in the Patient with Arrhythmogenic Right Ventricular Cardiomyopathy

概要

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Aims: Ventricular tachycardia (VT) originating from left ventricular papillary muscle has been reported. However, VT originating from right ventricular papillary muscle was rare. Results: A 74-year-old male underwent implantable cardioverter defibrillator (ICD) implantation for VT with arrhythmogenic right ventricular cardiomyopathy (ARVC) in 2008. However, he referred to our hospital with palpitation attack in 2010. VT of 105 bpm with its morphology of left bundle branch block pattern, superior axis, was documented in 12-lead electrocardiogram during attack, and we performed electrophysiological study. Clinical VT was induced by programmed stimuli from right ventricle (RV). Diastolic potential preceded by 65 ms from surface QRS onset was recorded by mapping catheter located in RV base during VT. We confirmed concealed entrainment by burst pacing and perfect pace mapping was acquired at this region. Delivery of radiofrequency energy from this region could eliminate VT. After catheter ablation, any VT was not induced by programmed stimulation with or without isoproterenol infusion. Ablation success site was confirmed as RV papillary muscle by electro-anatomical mapping system and intra-cardiac echocardiography. Conclusion: In the patient with ARVC, VT may originate from RV papillary muscle. The VT mapping is difficult because of the complex anatomy of RV papillary muscles. Several imaging technologies are useful for identify the site of VT origin.