Multicenter Outcomes for Catheter Ablation of Idiopathic Premature Ventricular Complexes

doi:10.1016/j.jacep.2015.04.005

JACC: Clinical Electrophysiology

Volume 1, Issue 3, June 2015, Pages 116-123

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Abstract

Objectives

This study reports multicenter outcomes and complications for catheter ablation of premature ventricular complexes (PVCs) and investigates predictors of procedural success, as well as development of PVC-induced cardiomyopathy.

Background

Catheter ablation of frequent idiopathic PVCs is used to eliminate symptoms and treat PVC-induced cardiomyopathy. Large-scale multicenter outcomes and complication rates have not been reported.

Methods

This retrospective cohort study included 1,185 patients (55% female; mean age 52 ± 15 years; mean ejection fraction 55 ± 10%; mean PVC burden 20 ± 13%) who underwent catheter ablation for idiopathic PVCs at 8 centers between 2004 and 2013. The following factors were evaluated: patient demographics, procedural characteristics, complication rates, and clinical outcomes.

Results

Acute procedural success was achieved in 84% of patients. In centers at which patients were followed up routinely with post-ablation Holter monitoring, continued success at clinical follow-up without use of antiarrhythmic drugs was 71%. Including the use of antiarrhythmic medications, the success rate at a mean of 1.9 years of follow-up was 85%. In a multivariate analysis, the significant predictors of acute success were PVC location and number of distinct PVC configurations (p < 0.03). The only significant predictor of continued success at clinical follow-up was a right ventricular outflow tract PVC location (p < 0.01). 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 (p < 0.05). The overall complication rate was 5.2% (2.4% major complications and 2.8% minor complications), and complications were most commonly related to vascular access (2.8%). There was no procedure-related mortality.

Conclusions

Catheter ablation of frequent PVCs is a low-risk and often effective treatment strategy to eliminate PVCs and associated symptoms. In patients with PVC-induced cardiomyopathy, cardiac function is frequently restored after successful ablation.

Key Words

ablation

cardiomyopathy

complications

outcomes

premature ventricular complexes

Abbreviations and Acronyms

confidence interval

ECG

electrocardiogram

left ventricular

MRI

magnetic resonance imaging

odds ratio

PVC

premature ventricular complex

RVOT

right ventricular outflow tract

Cited by (0)

: Dr. Tilz has received research grants from Hansen and St. Jude Medical; travel grants from St. Jude Medical, Topera, Biosense Webster, Daiichi-Sankyo, and Sentreheart; and speakers bureau honoraria from Biosense Webster, Biotronik, Pfizer, Topera, Bristol-Myers Squibb, Bayer, and Sanofi Aventis. Dr. Kuck has received research grants and speakers bureau honoraria from St. Jude Medical, Medtronic, and Abbott Vascular; and has served as a consultant to St. Jude Medical. Dr. Tedrow has received minor honoraria from St. Jude Medical, Medtronic, and Boston Scientific. Dr. Stevenson has a patent for needle ablation consigned to Brigham and Women’s Hospital, with no financial benefit at present. Dr. Hindricks has received research grants from St. Jude Medical, Biotronik, and Boston Scientific. Dr. Daoud is a member of the advisory board for Medtronic; a member of the advisory board for Biosense Webster; and a research investigator for St. Jude Medical, Biosense Webster, Medtronic, and Biotronik. Dr. Bogun is supported by the Leduqu Foundation. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.