Worsening of mitral valve regurgitation after radiofrequency catheter ablation of ventricular arrhythmia originating from a left ventricular papillary.

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Presentation transcript:

Worsening of mitral valve regurgitation after radiofrequency catheter ablation of ventricular arrhythmia originating from a left ventricular papillary muscle Atsushi Mochizuki, MD, Daigo Nagahara, MD, PhD, Hirohito Takahashi, Rei Saito, MD, Takefumi Fujito, MD, Tetsuji Miura, MD, PhD HeartRhythm Case Reports Volume 3, Issue 4, Pages 215-218 (April 2017) DOI: 10.1016/j.hrcr.2017.01.003 Copyright © 2017 Heart Rhythm Society Terms and Conditions

Figure 1 Surface electrocardiogram (50 mm/s) and intracardiac electrocardiogram (200 mm/s). A: Sinus rhythm and nonsustained ventricular tachycardia (NSVT) in the first session. B: Sinus rhythm and NSVT in the second session. C: An excellent pace map at a mid-level of the posterior papillary muscle in the second session. D: Intracardiac electrocardiogram at the successful ablation site in the second session. Prepotential (indicated by arrow) preceded the onset of the surface QRS complex by 22 ms during NSVT. HeartRhythm Case Reports 2017 3, 215-218DOI: (10.1016/j.hrcr.2017.01.003) Copyright © 2017 Heart Rhythm Society Terms and Conditions

Figure 2 A: Echocardiography before the first session showed moderate mitral valve regurgitation. B: Echocardiography before the second session showed severe mitral valve regurgitation. A4C = apical 4-chamber view. HeartRhythm Case Reports 2017 3, 215-218DOI: (10.1016/j.hrcr.2017.01.003) Copyright © 2017 Heart Rhythm Society Terms and Conditions

Figure 3 Three-dimensional electroanatomic mapping and late gadolinium–enhanced cardiac magnetic resonance imaging. A: SoundMap of the left ventricle including anterior papillary muscle (APM) and posterior papillary muscle (PPM) in the first session in right anterior oblique (RAO) view. White tags indicate ablation sites in left posterior fascicular (LPF) area, purple tag indicates a best pace-map site, green tags indicate bonus application sites with 45 W, and other tags (VisiTag) indicate ablation sites with 40 W. B: SoundMap in left anterior oblique (LAO) view in the first session. C: Late gadolinium–enhanced cardiac magnetic resonance imaging before the second session revealed myocardial late gadolinium enhancements at the LPF area and both left ventricular papillary muscles (indicated by arrows). HeartRhythm Case Reports 2017 3, 215-218DOI: (10.1016/j.hrcr.2017.01.003) Copyright © 2017 Heart Rhythm Society Terms and Conditions