Long-term Mode and Timing of Premature Ventricular Complex Recurrence Following Successful Catheter Ablation

Overview

Journal J Interv Card Electrophysiol

Publisher Springer

Date 2019 Feb 9

PMID 30734139

Citations 4

Authors

Derek Lee

Kurt S Hoffmayer

Jonathan C Hsu

Amir Schricker

Ulrika Birgersdotter-Green

Farshad Raissi

Gregory K Feld

David E Krummen

Affiliations

Soon will be listed here.

Abstract

Purpose: Catheter ablation of premature ventricular contractions (PVCs) is highly successful and has become the hallmark treatment for symptomatic or highly prevalent cases. However, few studies exist that evaluate the outcomes of ablation and likely mechanisms of PVC recurrence beyond 1 year of follow-up.

Methods: This study is a retrospective analysis of patients who underwent catheter ablation for symptomatic PVCs with acute procedural success and had clinical follow-up ≥ 12 months.

Results: Forty-four patients (24 women; age 53.5 ± 4.8 years) following acutely successful PVC ablation with long-term follow-up were studied. At a mean of 36 ± 6 months, overall long-term ablation success was 75% (33/44 patients). Notably, recurrence of the targeted PVC focus was low (6.8%, 3/44 patients); the majority of recurrences were from a new source location (18.2%, 8/44 patients). The time course for targeted versus de novo PVC recurrences was significantly different: recurrence of a PVC similar to the targeted PVC morphology occurred at a mean of 5.0 ± 2.0 months, while recurrence of a PVC different from the index case occurred at a mean of 35.8 ± 17.1 months (p = 0.01). Non-ischemic cardiomyopathy was associated with increased risk of PVC recurrence (odds ratio [OR] 14.50 (95% confidence interval [CI] 1.92-109.33, p = 0.01)) and was a significant negative prognostic factor in multivariate analysis for PVC recurrence survival (hazard ratio [HR] 4.63, 95% CI 1.03-20.74, p = 0.04).

Conclusions: The majority of long-term PVC recurrences occur late in follow-up, at locations remote from the targeted PVC source or sources. Such sites may represent ongoing substrate evolution; additional work is required to determine the precise substrate alterations which promote such arrhythmogenic changes.

Citing Articles

High Burden Ventricular Ectopy > 10% in Children with Structurally Normal Hearts: Investigating the Association of Ventricular Ectopy Frequency, Holter and ECG Findings, and Ventricular Dysfunction.

Aldrich J, Daniels Z, Eisner M, Kistler I, Bowman J, Hor K Pediatr Cardiol. 2024; .

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Empiric catheter ablation of premature ventricular contractions when there is a >20% burden in an asymptomatic patient with normal left ventricular size and function-An argument for a conservative, do-less approach.

Hoffmayer K Heart Rhythm O2. 2021; 2(2):210-214.

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Improvement in Exercise Tolerance after Catheter Ablation for Premature Ventricular Complexes: A Case Report.

Miki T, Shiraishi H, Shirayama T, Matoba S Prog Rehabil Med. 2020; 5:20200028.

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The effect of idiopathic premature ventricular complexes on left ventricular ejection fraction.

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