The tip of the muscle is a dominant location of ventricular ectopy originating from papillary muscles in the left ventricle

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Frequent ventricular premature complexes (VPCs) may cause symptoms and/or lead to deterioration of left ventricular (LV) systolic function.1 Although frequent VPCs may be abolished by catheter ablation,2 it may be challenging in case of their origin from the LV papillary muscles (PMs). Recently, Latchamsetty et al.3 demonstrated in a collaborative study that radiofrequency (RF) ablation of VPCs originating from the PMs was associated with relatively low success rates (60%), high recurrence rate, long procedure times, and the delivery of large amounts of RF energy.
PMs are complex anatomical structures of variable size and geometry. Previous studies on ablation of PMs related ectopy4 identified the problems associated with ablation procedure in detail. They described difficulty obtaining stable catheter‐tissue contact because of high mobility of PMs and limited efficacy of pace mapping. In some studies, changing morphology of the ectopy was observed during ablation. As a result, extensive ablation was usually necessary to obtain acceptable outcome. Although most of studies on PM ablation used RF energy, cryoenergy was reported as beneficial in one small series of 12 patients.14 Nearly all studies universally highlighted the importance of using intracardiac echocardiography (ICE) that allowed real‐time visualization of PMs and catheter–tissue contact.
Current knowledge regarding ablation of PM‐related arrhythmias is based on small, single‐center case series. Our aim was to analyze the outcome of ablation of these arrhythmias in a larger collaborative multicenter study with emphasis on PM morphology and location of the ectopic foci as visualized by ICE.
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