Biventricular false tendons

False chordae tendineae or false tendons (FTs) are fibrous or fibro-muscular structures and sometimes also conduction tissue, blood vessels, and Purkinje cells that cross the ventricular cavities without connections to the valve cusps.1 Typically, they connect the free wall of the left ventricle or the papillary muscles and the ventricular septum, although they can also be found in the right ventricle.2 FTs must be distinguished from other entities, such as thickened ventricular trabeculae or ventricular masses. Most FTs are transverse and located at the apex; however, they may also be located in the apical, middle, or basal third in a diagonal or longitudinal orientation. They can be simple, with 1-2 insertion points, or branched with 3 or more insertion points.3 The exact prevalence of FTs in the general population varies widely, ranging from 0.4% to 83%.3 FTs appear to be higher in the pediatric age group.4 FTs are generally considered benign anatomic variants; however, they may be associated with varied entities, including precordial murmurs, repolarization abnormalities, preexcitation, mitral regurgitation, ventricular arrhythmias, and abnormal cardiac remodeling with systolic and diastolic dysfunction and dilatation of the left ventricle.3-5 FTs may be associated with electrocardiographic changes, especially in young sportspersons.6 Regarding ventricular arrhythmias, it has been suggested that they may be triggered by stretching the ventricular septum by FTs, resulting in increased automaticity. In this setting, it is suggested that FT may contain elements that are part of the cardiac excitation conduction system or cause excessive tension of Purkinje fibers in the cardiac septum. In addition, abnormal electrical impulses and re-entry circuits may be caused by fibrous tissue in FTs.6 However, the exact etiopathological mechanism of FT-induced cardiac changes remains unclear.