Multicenter Outcomes for Catheter Ablation of Idiopathic Premature Ventricular Complexes

Rakesh Latchamsetty; Miki Yokokawa; Fred Morady; Hyungjin Myra Kim; Shibu Mathew; Roland Tilz; Karl-Heinz Kuck; Koichi Nagashima; Usha Tedrow; William Gregory Stevenson; Ricky Yu; Roderick Tung; Kalyanam Shivkumar; Jean-Francois Sarrazin; Arash Arya; Gerhard Hindricks; Rama Vunnam; Timm Dickfeld; Emile G Daoud; Nishaki M Oza; Frank Bogun

doi:10.1016/j.jacep.2015.04.005

Multicenter Outcomes for Catheter Ablation of Idiopathic Premature Ventricular Complexes

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

Authors

Rakesh Latchamsetty¹, Miki Yokokawa², Fred Morady², Hyungjin Myra Kim³, Shibu Mathew⁴, Roland Tilz⁴, Karl-Heinz Kuck⁴, Koichi Nagashima⁵, Usha Tedrow⁵, William Gregory Stevenson⁵, Ricky Yu⁶, Roderick Tung⁶, Kalyanam Shivkumar⁶, Jean-Francois Sarrazin⁷, Arash Arya⁸, Gerhard Hindricks⁸, Rama Vunnam⁹, Timm Dickfeld⁹, Emile G Daoud¹⁰, Nishaki M Oza¹⁰, Frank Bogun²

Affiliations

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.

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

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.