Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 26, 2020; 8(2): 325-330
Published online Jan 26, 2020. doi: 10.12998/wjcc.v8.i2.325
Catheter ablation of premature ventricular complexes associated with false tendons: A case report
Ya-Bing Yang, Xiao-Feng Li, Ting-Ting Guo, Yu-He Jia, Jun Liu, Min Tang, Pi-Hua Fang, Shu Zhang
Ya-Bing Yang, Cardiovascular Medicine Department, Beijing Renhe Hospital, Beijing 102600, China
Xiao-Feng Li, Ting-Ting Guo, Yu-He Jia, Jun Liu, Min Tang, Pi-Hua Fang, Shu Zhang, Center for Cardiac Arrhythmia, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of China, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
Author contributions: Yang YB and Li XF participated in collecting data, and drafted the manuscript; Jia YH carried out the studies, Tang M participated in its design; All authors read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Yu-He Jia, MD, Doctor, Center for Cardiac Arrhythmia, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of China, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing 100037, China. jiayuhejyh@163.com
Received: October 31, 2019
Peer-review started: October 31, 2019
First decision: November 19, 2019
Revised: December 9, 2019
Accepted: December 13, 2019
Article in press: December 13, 2019
Published online: January 26, 2020
Abstract
BACKGROUND

False tendon is a common intraventricular anatomical variation. It refers to a fibroid or fibromuscular structure that exists in the ventricle besides the normal connection of papillary muscle and mitral or tricuspid valve. A large number of clinical studies have suggested that there is a significant correlation between false tendons and premature ventricular complexes. However, few studies have verified this correlation during radiofrequency catheter ablation of premature ventricular complexes.

CASE SUMMARY

A 45-year-old male was admitted to receive radiofrequency ablation for symptomatic premature ventricular complexes. A three-dimensional model of the left ventricle was established by intracardiac echocardiography using the CartoSoundTM mapping system. In addition to the left anterior papillary muscle, the posterior papillary muscle was mapped. False tendons were found at the base of the interventricular septum, and the other end was connected to the left ventricular free wall near the apex. An irrigated touch force catheter was advanced into the left ventricle via the retrograde approach. The earliest activation site was marked at the interventricular septum attachment of the false tendons and was successfully ablated.

CONCLUSION

This case verified that false tendons can cause premature ventricular complexes and may be cured by radiofrequency ablation guided by intracardiac echocardiography with the CartoSoundTM system.

Keywords: Intracardiac echocardiography, CartoSoundTM, Radiofrequency catheter ablation, Premature ventricular complexes, False tendons, Case report

Core tip: We report a case of successful radiofrequency catheter ablation of premature ventricular complexes associated with left ventricular false tendons. Intracardiac echocardiography with the CartoSoundTM system was used to demonstrate, for the first time, that the occurrence of ventricular premature complexes was associated with false tendons. No classical Purkinje potential and special potential were observed following interventricular septum attachment of false tendons, the local potential of the target region in this patient, and the ectopic excitability resulting in mechanical traction at the false tendon attachment site of the interventricular septum may be a possible mechanism for these premature ventricular complexes.