Catheter ablation of papillary muscle arrhythmias: implications of mitral valve prolapse and systolic dysfunction

The left ventricular papillary muscles are important components of the mitral valve apparatus. Catheter ablation of ventricular arrhythmias from these sites is challenging. We aim to describe the association between LV papillary muscle ventricular arrhythmias (VAs) and mitral valve prolapse (MVP), and to determine the outcomes of ablation in these patients with a focus on those with MVP and cardiomyopathy.152 patients underwent 170 consecutive procedures for ablation of focal VAs. Mitral valve prolapse and cardiomyopathy were diagnosed by echocardiography. Outcomes following ablation were assessed in 3 groups: i) LV papillary muscle VAs vs other sites ii) LV papillary muscle VAs by the presence of MVP iii) LV papillary muscle VAs in the setting of cardiomyopathy.9 of 23 (39%) patients undergoing ablation of LV papillary muscle VAs had MVP compared to none of 129 (0%) patients at other sites (p\ua