Successful Catheter Ablation Under ECMO for Fatal Ventricular Tachycardia from RV Papillary Muscle in an Infant

Right ventricular papillary muscle (RVPM)-originating ventricular tachycardia (VT) is a potentially life-threatening arrhythmia that can rapidly lead to hemodynamic collapse. To the best of our knowledge, no cases have been reported in infants. We present the case of a 2-month-old male who developed RVPM-VT and subsequently underwent successful catheter ablation while on extracorporeal membrane oxygenation (ECMO). Due to the risk of air entry through the sheath from ECMO suction, catheter exchange was performed in a water-filled tray. Pace mapping was utilized to accurately localize the VT origin, followed by ablation using an irrigated catheter, which effectively delivered the necessary power to ablate the RVPM. The VT was successfully terminated post-ablation, with no recurrence observed.