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JACC Clin Electrophysiol. 2015 Jun;1(3):116-123. doi: 10.1016/j.jacep.2015.04.005. Epub 2015 Apr 27.

Multicenter Outcomes for Catheter Ablation of Idiopathic Premature Ventricular Complexes.

Author information

1
Division of Electrophysiology, Department of Medicine, University of Michigan, Ann Arbor, Michigan. Electronic address: rakeshl@umich.edu.
2
Division of Electrophysiology, Department of Medicine, University of Michigan, Ann Arbor, Michigan.
3
Biostatistics Department, School of Public Health, University of Michigan, Ann Arbor, Michigan.
4
Division of Electrophysiology, Department of Medicine, Asklepios Klinik St. Georg, Hamburg, Germany.
5
Division of Electrophysiology, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
6
Division of Electrophysiology, Department of Medicine, University of California, Los Angeles.
7
Division of Electrophysiology, Department of Medicine, Institut Universitaire de Cardiologie et Pneumologie de Quebec, Quebec, Canada.
8
Division of Electrophysiology, Department of Medicine, University Leipzig Heart Center, Leipzig, Germany.
9
Division of Electrophysiology, Department of Medicine, University of Maryland, Baltimore, Maryland.
10
Division of Electrophysiology, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio.

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.

KEYWORDS:

ablation; cardiomyopathy; complications; outcomes; premature ventricular complexes

PMID:
29759353
DOI:
10.1016/j.jacep.2015.04.005
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