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Reversible cardiomyopathy provoked by focal ventricular arrhythmia originating from the base of the posterior papillary muscle

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Abstract

Background

A new distinct clinical syndrome comprising of ventricular tachycardia or frequent premature beats arising from the base of the posterior papillary muscle has recently been reported. The cardiac arrhythmia had a non-reentrant mechanism and none of the patients had left ventricular dysfunction.

Case report

We report on a 55-year-old female patient presenting with a dilated cardiomyopathy and frequent ventricular premature beats (VPB). Ventricular arrhythmia was refractory to amiodarone. Eighteen months after the onset of palpitations the patient evolved from NYHA functional class I to class III, with a LVEF of 38%. VPB comprised 26% of the total number of QRS complexes during 24 h Holter monitoring, which also recorded 12 salvos of non-sustained VT. NT-pro BNP level was 1,080 mcg/ml. During electrophysiologic study LV geometry was reconstructed with Ensite NAVX® system which allowed voltage and activation mapping. We found neither scar-like nor low-voltage tissue in the endocardial surface of the LV. VPB was mapped in a site at the base of the posterior papillary muscle, which was confirmed by LV angiography. Cool-tip catheter ablation successfully eliminated VPB. Three months later, the patient was in NYHA functional class I, NT-proBNP level was 98 mcg/ml, with partial LV reverse remodeling and LVEF of 58%. Twenty-four hours Holter monitoring showed only 24 single premature beats.

Conclusion

Focal ventricular arrhythmia arising from the base of the left posterior papillary muscle can provoke significant left ventricular dysfunction. Left ventricular dysfunction reversed after elimination of the VPB.

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Acknowledgements

We would like to thank Mauricio Rezende Barbosa, M.D. and José Luiz Barros Pena, M.D., PhD for their assistance in revising hemodynamic and echocardiographic data, respectively.

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Authors and Affiliations

  1. Arrhythmia and Electrophysiology Unit, Biocor Instituto, Nova Lima, Brazil

    Eduardo Back Sternick, Frederico Correa, Ricardo Negri, Ricardo Baeta Scarpelli & Luiz Márcio Gerken

  2. Rua Correias 281, 301, CEP 30315-340, Belo Horizonte, Minas Gerais, Brazil

    Eduardo Back Sternick

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  1. Eduardo Back Sternick
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  2. Frederico Correa
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  3. Ricardo Negri
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  4. Ricardo Baeta Scarpelli
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  5. Luiz Márcio Gerken
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Correspondence to Eduardo Back Sternick.

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Sternick, E.B., Correa, F., Negri, R. et al. Reversible cardiomyopathy provoked by focal ventricular arrhythmia originating from the base of the posterior papillary muscle. J Interv Card Electrophysiol 25, 67–72 (2009). https://doi.org/10.1007/s10840-008-9341-z

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  • DOI: https://doi.org/10.1007/s10840-008-9341-z

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