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. 2022 Aug 11;24(12):1981–2003. doi: 10.1093/europace/euac125

Figure 8.

Figure 8

Typical examples of premature ventricular contractions arising from the mitral apparatus. Premature ventricular complexes (PVCs) arising from the posterior papillary muscle (PPM) are characterized by right bundle branch block (RBBB) morphology, a predominantly negative QRS in V5, QRS >130 ms and superior axis with both leads II and III negative. Foci in the anterior papillary muscle (APM) also yield a RBBB morphology, typically with a late R/S transition (V3 to V5), QRS >130 ms and lead II discordantly negative while lead III is positive. Ectopy originating from the mitral annulus result in RBBB morphology with positive precordial concordance. PVCs form the anterior mitral annulus (AMA) are defined by an inferior QRS axis while those originating from the posterior mitral annulus (PMA) result in a superior axis. Image courtesy of Jérôme Hourdain, MD, Hôpital la Timone, Marseilles, France.