Clinical Research
Heart Rhythm Disorders
Neurohormonal, Structural, and Functional Recovery Pattern After Premature Ventricular Complex Ablation Is Independent of Structural Heart Disease Status in Patients With Depressed Left Ventricular Ejection Fraction: A Prospective Multicenter Study

https://doi.org/10.1016/j.jacc.2013.06.012Get rights and content
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Objectives

This study aimed to assess the benefit after ablation of premature ventricular complexes (PVC) in patients with frequent PVC and left ventricular (LV) dysfunction, regardless of previous structural heart disease (SHD) diagnosis, PVC morphology, or estimated site of origin.

Background

Ablation of PVC in patients with LV dysfunction is usually restricted to patients with suspected PVC-induced cardiomyopathy.

Methods

Consecutive patients with frequent PVC and LV dysfunction accepted for ablation at 4 centers were prospectively included. Of the 80 patients included, 27 (34%) had a diagnosis of SHD.

Results

Successful sustained ablation (SSA) was achieved in 53 (66%) patients, and LVEF improved in these patients from 33.7 ± 8% to 43.8 ± 9.4% and 45.8 ± 10.9% at 6 and 12 months, respectively (p < 0.05), without differences related to previous diagnosis of SHD (p = 0.69). BNP decreased from 109 [64 to 242] pg/ml to 60 [25 to 170] pg/ml, 50 [14 to 130] pg/ml, and 60 [19 to 81] pg/ml at 1, 6, and 12 months (p < 0.05). Patients in NYHA class I increased from 12 (23%) to 42 (79%) at 12 months (p < 0.05). A 13% baseline PVC burden had 100% sensitivity and 85% specificity to predict an absolute increase ≥5% in LVEF after SSA. Although 20 patients with >13% PVC and SSA had class I indication for cardioverter defibrillator implantation, these indications were absent at 6 months post-ablation.

Conclusions

Independently of the presence of SHD, the SSA of frequent PVC in patients with depressed LVEF induced a progressive clinical and functional improvement. Improvement in heart failure parameters was related to baseline PVC burden and persistence of ablation success.

Key Words

premature ventricular complexes
radiofrequency catheter ablation
structural heart disease

Abbreviations and Acronyms

BNP
brain natriuretic peptide
ce-CMR
contrast-enhanced cardiac magnetic resonance
ECG
electrocardiogram
ICD
implantable cardioverter-defibrillator
IHD
ischemic heart disease
LVEF
left ventricular ejection fraction
NT proBNP
N-terminal pro brain natriuretic peptide
NYHA
New York Heart Association
PVC
premature ventricular complex
RFCA
radiofrequency catheter ablation
SHD
structural heart disease
SOO
site of origin
SSA
successful sustained ablation
VT
ventricular tachycardia

Cited by (0)

Dr. Heras has received consultancy fees and lectures fees from AstraZeneca, Menarini, and Novartis. Dr. van Huls van Taxis has received funding from the Netherlands Heart Society (grant no. 2008B074). Dr. Mont has received consultant's fees from Boston Scientific, St. Jude Medical, and Biosense; has received research grants from Bard, Biosense, Biotronik, Boston Scientific, Medtronic, Sorin, and St. Jude Medical; and has received lecturer's honoraria from Biosense, Biotronik, Boston Scientific, Medtronic, Sorin, and St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.