Worsening of mitral valve regurgitation after radiofrequency catheter ablation of ventricular arrhythmia originating from a left ventricular papillary muscle

Introduction Papillary muscles (PMs) of the left ventricle (LV) have been shown to be a potential origin of ventricular arrhythmias (VAs) in patients with or without structural heart disease. Recently, a “malignant” arrhythmia phenotype in patients with mitral valve prolapse (MVP) who experienced lifethreatening VAs has been reported. This subset of patients with MVP was characterized by complex ventricular ectopy arising from one or both of the PMs, fascicular tissue, and outflow tracts, and the arrhythmias have been shown to be successfully treated by catheter ablation (CA). Mitral valve dysfunction after radiofrequency (RF) CA of VAs of PM origin has been described in only 1 report, to our knowledge. Here we report a patient with a history of MVP and nonsustained ventricular tachycardia (NSVT) originating from the left ventricular posterior PM (PPM). Her ventricular tachycardia (VT) was successfully eliminated by repeated RF CA, but mitral valve regurgitation (MR) worsened from moderate to severe after CA. She underwent mitral valvuloplasty 8 months after the first CA session.