Outcomes for Ablation of Idiopathic PVCs | Journal Scan

Study Questions:

What are the procedural success, complications, and outcomes of catheter ablation for premature ventricular complexes (PVCs)?

Methods:

This retrospective cohort study included 1,185 patients (55% female, mean age 52, mean ejection fraction 55%, mean PVC burden 20%) who underwent catheter ablation for idiopathic PVCs at eight centers.

Results:

In 84% of all patients, PVCs were eliminated at the completion of the procedure. Continued success without use of antiarrhythmic drugs occurred in 71% of patients with a mean follow-up of 1.9 years. In a multivariate analysis, the only significant predictor of long-term success was a right ventricular outflow tract PVC location. In 245 patients (21%) with PVC-induced cardiomyopathy, the mean ejection fraction improved from 38% to 50% (p < 0.01) after ablation. Independent predictors for development of PVC-induced cardiomyopathy were male gender, PVC burden, lack of symptoms, and epicardial PVC origin. The overall complication rate was 5.2%, and complications were most commonly related to vascular access (2.8%). There was no procedure-related mortality.

Conclusions:

The authors concluded that catheter ablation of frequent PVCs is a low-risk endeavor and is often effective. In patients with PVC-induced cardiomyopathy, cardiac function frequently improves after a successful ablation.

Perspective:

This study, involving eight international centers, presents the largest experience to date of catheter ablation for idiopathic PVCs. It demonstrates that ablation in the hands of experienced operators is highly effective in eliminating PVCs, especially when they originate in the right ventricular outflow tract, and may improve cardiomyopathy in select patients. Predictors of ablation failure are intuitive: epicardial origin and multiple PVC morphologies. Future studies should focus on randomized design, consistent data collection with serial imaging and Holter studies, as well as objective assessment of cardiopulmonary performance in patients with low ejection fraction at baseline and at follow-up.

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Implantable Devices, EP Basic Science, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure

Keywords: Anti-Arrhythmia Agents, Arrhythmias, Cardiac, Cardiomyopathies, Catheter Ablation, Cohort Studies, Follow-Up Studies, Heart Failure, Heart Ventricles, Multivariate Analysis, Retrospective Studies, Treatment Outcome, Ventricular Premature Complexes


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