Ablation of Ventricular Tachycardia Originating From the Papillary Muscle of the Left Ventricle Early After Heart Transplantation
A 46-year-old man 2 months status post heart transplant for cardiac amyloidosis was admitted with recurrent palpitations. There was no reported ventricular dysfunction or history of ventricular arrhythmia in the donor, a 26-year-old man who died in a motorcycle accident.
Monomorphic ventricular tachycardia (VT) was observed in the second week after heart transplant. Echocardiogram revealed preserved graft function with left ventricular ejection fraction of 55%, and endomyocardial biopsy revealed no evidence of rejection. The patient was treated with metoprolol with reduction in his VT burden, but he subsequently signed out of the hospital against medical advice. Three weeks later, he presented to the emergency department with recurrent palpitations. Cardiac monitoring showed frequent ventricular premature complexes and VT (as many as 30 beats), with right bundle branch block morphology QRS configuration and rightward frontal axis—identical to the early postoperative arrhythmia (Figure, panel A). An …