Delayed papillary muscle rupture after radiofrequency catheter ablation: A case report

Figure 1 Final effective ablation target. A: Electroanatomic map exhibiting the earliest activation site (the green tag); B: Intracardiac echocardiographic image at the level of the papillary muscle; C: Complex fractional prepotential preceding the surface QRS at 20 ms was recorded (the green tag). LAO: Left anterior oblique.

Figure 2 Mitral valve and papillary muscle 2 wk after radiofrequency catheter ablation. A and B: Echocardiographic image showing massive mitral regurgitation and ruptured mitral valve leaflet which was entering into the left atrium; C and D: The rupture of papillary muscles was found during mitral valve replacement; E: The mitral valve was cut off during the surgery. Arrows show the end of the rupture of papillary muscles.

Figure 3 Pathological examination of the papillary muscles and chordae tendineae. A: The papillary muscle underwent necrosis after radiofrequency catheter ablation (RFCA), appearing as karyolysis; B: There was no necrosis in the chordae tendineae, indicating that the chordae tendineae was not damaged after RFCA.