Advanced imaging integration: A miter saw that cuts the complexity of papillary muscle premature ventricular contractions

The mitral valve is named after a miter—a tall headdress worn by bishops and senior abbots as a symbol of office, tapering to a point at front and back with a deep cleft between them. It is an apt name that reflects the structure and complexity of one of the atrioventricular valves of the human heart. Ventricular arrhythmias (VAs) originating from the scaffoldings of this structure—the papillary muscles (PAPs)—are notorious for being difficult to map and ablate because of multiple reasons including the preferential exit of an intramuscular focus, movement of the structure, and difficulty in attaining catheter stability and the depth needed to attain irreversible myocardial injury to affect the site of the origin of these arrhythmias with traditional ablation modalities. Implications of the anatomy of papillary muscle connections for mapping and ablation of focal ventricular arrhythmiasHeart RhythmVol. 20Issue 10PreviewVentricular arrhythmias (VAs) originating from papillary muscles (PAPs) can be challenging when targeted with catheter ablation. Reasons may include premature ventricular complex pleomorphism, structurally abnormal PAPs, or unusual origins of VAs from PAP–myocardial connections (PAP-MYCs). Full-Text PDF