Effectiveness of Carvedilol on Premature Ventricular Complexes Originating from the Bilateral Papillary Muscles in the Left Ventricle

概要

論文の詳細を見る
It has been reported that idiopathic focal ventricular arrhythmias can originate from the papillary muscles in the left ventricle (LV), but the clinical features remains unclear and the treatment has not been established. We report on a 75-year-old male patient presenting with a dilated cardiomyopathy and frequent ventricular premature complexes (VPCs). Ventricular arrhythmia was refractory to betaxolol (10 mg), mexiletine (300 mg) and Atenolol (25 mg). Three years after the onset of palpitations the patient evolved from NYHA functional class I (NYHAI) to class III, with a LVEF of 28%. VPCs comprised 66% of the total number of QRS complexes during 24 h Holter monitoring (Holter). During electrophysiologic study LV geometry was reconstructed using a CARTO system and the activation maps for two types of frequent VPCs revealed centrifugal activation patterns from two separate sites at the anterior and posterior papillary muscle. Radiofrequency catheter ablation was performed, but could not eliminate VPCs. Then, Carvedilol, at a dose of 20 mg/day, was administrated and suppressed VPCs very effectively. One year later, the patient was in NYHAI with LV reverse remodeling and LVEF of 51%. Holter showed only 727 VPCs. In conclusion, frequent VPCs arising from the bilateral left papillary muscle induced significant LV dysfunction and it was supressed effectively with Carvedilol, following LV reverse remodeling.