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Delayed papillary muscle rupture after radiofrequency catheter ablation: A case report
Ze-Wei Sun1, Bi-Feng Wu1, Xuan Ying1
1Department of Cardiology, Zhejiang University, Hangzhou 310000, Zhejiang Province, China.
Background:
With an increased number of surgical procedures involving the mitral annular region, the risk of mitral valve prolapse (MVP) has also increased. Previous studies have reported that worsening of MVP occurred early after radiofrequency catheter ablation (RFCA) at papillary muscles in ventricular tachycardia (VT) patients with preoperative MVP.
Case Summary:
We report a case where MVP and papillary muscle rupture occurred 2 wk after RFCA in a papillary muscle originated VT patient without mitral valve regurgitation or prolapse before. The patient then underwent mitral valve replacement with no premature ventricular contraction or VT. During the surgery, a papillary muscle rupture was identified. Pathological examination showed necrosis of the papillary muscle. The patient recovered after mitral valve replacement.
Conclusion:
Too many ablation procedures and energy should be avoided.
Insights
Radiofrequency catheter ablation (RFCA) for ventricular tachycardia (VT) can lead to mitral valve prolapse (MVP) and papillary muscle rupture. Caution is advised regarding the number of ablation procedures and energy used to prevent these complications.
Area of Science:
- Cardiology
- Cardiac Electrophysiology
- Cardiovascular Surgery
Background:
- Increasing numbers of mitral annular region surgeries correlate with a higher risk of mitral valve prolapse (MVP).
- Prior research indicates MVP can worsen post-radiofrequency catheter ablation (RFCA) in ventricular tachycardia (VT) patients with pre-existing MVP.
Observation:
- A case study documented a patient developing MVP and papillary muscle rupture two weeks after RFCA for papillary muscle-originated VT.
- This patient had no prior mitral valve regurgitation or prolapse before the procedure.
Findings:
- Mitral valve replacement was successfully performed, resolving premature ventricular contractions and VT.
- Surgical examination revealed papillary muscle rupture, with pathological findings indicating necrosis.
Implications:
- Excessive ablation procedures and energy application in RFCA may increase the risk of severe mitral valve complications.
- This case highlights the importance of careful energy management during RFCA to prevent adverse cardiac events.
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