LAUSR

Ventricular premature complexes (VPCs) originating from the papillary muscle (PM) have high recurrence rates; 71% of anterolateral PM (ALPM) and 50% of posteromedial PM (PMPM) ventricular tachycardias (VTs), respectively.1 The main reasons for this difficulty may be poor catheter stability and its deep origin.1 To reduce symptoms and preserve left ventricular systolic function of patients with ventricular arrhythmias (VAs) arising from the PM, it is necessary to improve outcomes in PM VA ablation. Owing to the limited ability of creating transmural lesions with unipolar radiofrequency catheter ablation (RFCA), bipolar RFCA and RFCA guided by intracardiac echocardiography (ICE) and/or cryoablation2, 3 are considered the treatment options for PM VAs. Cryoablation has the advantage of catheter stability2, 3; on the other hand, bipolar RFCA allows deep lesion formation.4 Although concern remains that bipolar RFCA increases the risk of steam pops,5 Good and colleagues6 showed that the incidence of steam pops with bipolar RFCA with externally irrigated ablation catheter is lower than with sequential unipolar ablation. Besides, Nguyen and colleagues5 reported that large and deep lesions can be produced using externally irrigated ablation catheters as both the active and the ground. However, they also stated that when using an 8-mm-tip catheter as the active and an externally irrigated ablation catheter as the ground, the risk of steam pops will increase. We report a successful case of ALPM VPCs that was treated by bipolar RFCA.