Successful catheter ablation of a ventricular tachycardia storm originating from the left ventricular posterior papillary muscle involved with a remote myocardial infarction.

A 61-year-old man with a remote posterior myocardial infarction underwent electrophysiological testing for a ventricular tachycardia (VT) storm. Repeated cardioversions terminated the VT with immediate resumption after one sinus beat. Pacing neither terminated the VT nor demonstrated transient entrainment. Echocardiographically guided electroanatomic mapping revealed a centrifugal activation from the septal mid-apical region of the left ventricle on the septal portion of the posterior papillary muscle where a high frequency potential was observed within the local ventricular electrogram. Irrigated radiofrequency current at this site eliminated the VT. This case suggested that papillary muscles may be a target for catheter ablation of electrical storms after myocardial infarctions.