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Electrocardiographic and Electrophysiological Characteristics in Idiopathic Ventricular Arrhythmias Originating From the Papillary Muscles in the Left VentricleClinical Perspective by Takumi Yamada, Harish Doppalapudi, H. Thomas McElderry, Taro Okada, Yoshimasa Murakami, Yasuya Inden, Yukihiko Yoshida, Naoki Yoshida, Toyoaki Murohara, Andrew E. Epstein, Vance J. Plumb, Silvio H. Litovsky, and G. Neal Kay Circ Arrhythm Electrophysiol Volume 3(4):324-331 August 17, 2010 Copyright © American Heart Association, Inc. All rights reserved. The intracardiac echocardiographic images of the successful ablation site. Takumi Yamada et al. Circ Arrhythm Electrophysiol. 2010;3:324-331 Copyright © American Heart Association, Inc. All rights reserved. Cardiac tracings (left) and fluoroscopic images (right) exhibiting the successful ablation site of the PVCs originating from the LV PPM. The first beat is a sinus beat and the second a PVC. Note that at the successful ablation site, no Purkinje potentials were observed during sinus rhythm, and a spiky prepotential (arrowhead) was observed in the local ventricular activity during the PVC. ABL indicates ablation catheter; CS 1 to 5, the first to fifth electrode pair of the coronary sinus catheter; d, distal; HB, His bundle; LAO, left anterior oblique view; p, proximal; RAO, right anterior oblique view; RV, right ventricular catheter; V-QRS, local ventricular activation time relative to the QRS onset. Takumi Yamada et al. Circ Arrhythm Electrophysiol. 2010;3:324-331 Copyright © American Heart Association, Inc. All rights reserved. The 12-lead ECGs of the PVCs presumably originating from the LV APM and pace map obtained by pacing from the epicardial surface opposite the APM (left) and fluoroscopic images (right) exhibiting the ablation catheter positioned at the endocardial site of the earliest ventricular activation during the PVCs and at the epicardial site of pace mapping. Takumi Yamada et al. Circ Arrhythm Electrophysiol. 2010;3:324-331 Copyright © American Heart Association, Inc. All rights reserved. The 12-lead ECGs of the PVCs originating from the LV PPM and excellent pace maps (PMs) and an electroanatomic map exhibiting the radiofrequency ablation sites. Takumi Yamada et al. Circ Arrhythm Electrophysiol. 2010;3:324-331 Copyright © American Heart Association, Inc. All rights reserved. An autopsy specimen of the human heart exhibiting the distribution of the successful ablation sites (left) and representative 12-lead ECGs exhibiting the differences in the QRS morphology of the ventricular arrhythmias successfully ablated between both sides of the PAMs in the same patients (right). Takumi Yamada et al. Circ Arrhythm Electrophysiol. 2010;3:324-331 Copyright © American Heart Association, Inc. All rights reserved. The 12-lead ECGs exhibiting a spontaneous change in the QRS morphology during the ventricular tachycardia originating from the LV PPM. Takumi Yamada et al. Circ Arrhythm Electrophysiol. 2010;3:324-331 Copyright © American Heart Association, Inc. All rights reserved.