Does the origin of ablated premature ventricular contractions determine the level of left ventricular function improvement?

Abstract

Background: Premature ventricular contractions (PVCs) are associated with tachycardiomyopathy and high mortality rate. The treatment depends on the engaged ventricle. For PVCs originating from the right outflow tract (OT), radiofrequency catheter ablation (RFCA) is recommended (class IB‑R recommendation) in preference to pharmacotherapy. In those originating from the left ventricle, ablation is a class IIa B‑NR recommendation.

Aims: The aim of the study was to assess the success of RFCA of PVCs based on arrhythmia origin.

Methods: A total of 110 consecutive patients with monomorphic PVCs referred for ablation were enrolled and divided according to the site of ablation to the OT group and the ventricles (VENT) group. Holter electrocardiography and echocardiography were performed before the procedure and at 6‑month follow‑up.

Results: Long‑term RFCA success was achieved in 93 (85%) patients (89% in the OT group and 82% in the VENT group; P = 0.39). The PVC reduction was similar in both groups (median [interquartile range] 99.55% [14] and 99.88% [6], respectively; P = 0.56). The OT group presented greater left ventricle (LV) recovery than the VENT group (odds ratio, 2.01; 95% CI, 1.15–10.75; P = 0.015). The procedure in the VENT group was longer, required additional access, the complication rate was similar, and 1 serious adverse event (aortic dissection) was observed in a patient with arrhytmia originating in the LV outflow tract.

Conclusions: The origin of PVCs does not determine the success of arrhythmia elimination. The OT origin may predict LV improvement. The duration of RFCA in the VENT group was longer. The outflow tract origin may predict reversal of LV deterioration.