Efficacy of catheter ablation for premature ventricular contractions in arrhythmogenic right ventricular cardiomyopathy

Abstract

Background Premature ventricular contractions (PVCs) may be found in any stage of arrhythmogenic right ventricular cardiomyopathy (ARVC) and have been associated with the risk of sustained ventricular tachycardia (VT). Objective To investigate the role of PVC ablation in ARVC patients. Methods We studied consecutive ARVC patients who underwent PVC ablation due to symptomatic high PVC burden. Mean daily PVC burden and antiarrhythmic drug (AAD) use were assessed before and after the procedure. Complete long‐term success was defined as more than 80% reduction in PVC burden off of membrane‐active AADs. Results Eight patients (37 ± 15 years; 4 males) underwent PVC ablation. The mean daily PVC burden before ablation ranged from 5.4% to 24.8%. A total of 7 (87.5%) patients underwent epicardial ablation. Complete acute elimination of PVCs was achieved in 4 (50%) patients (no complications). The mean daily PVC burden variation ranged from an 87% reduction to a 26% increase after the procedure. Over a median follow‐up of 345 days (range: 182–3004 days), only one (12.5%) patient presented complete long‐term success, and 6 (75%) patients either maintained or increased the need for Class I or Class III AADs. A total of 2 (25%) patients experienced sustained VT for the first time following the ablation procedure, requiring repeat ablation. No death or heart transplantation occurred. Conclusion PVC ablation was not associated with a consistent reduction of the PVC burden in ARVC patients with symptomatic, frequent PVCs. PVC ablation may be reserved for highly symptomatic patients who failed AADs. Additional investigation is required to improve the efficacy of PVC ablation in ARVC patients.

Elucidating arrhythmogenic right ventricular cardiomyopathy with stem cells

“…Indeed, studies in humans with ARVC demonstrated initiation of ventricular tachycardia by ventricular ectopy produced by catecholamine infusion (Philips et al, 2013 ), which is consistent with the clinical presentation of sudden death in ARVC patients during exercise. Interestingly, even though PVC burden is mechanistically related to arrhythmia, ablation of PVCs in patients with ARVC was recently shown to be largely ineffective (Assis et al, 2021 ), whereas ablation of VT has some success (Bai et al, 2011 ), suggesting a deeper understanding is necessary for more effective treatments.…”

Does catheter ablation for premature ventricular contractions remain unsuccessful in arrhythmogenic right ventricular cardiomyopathy?

“…We have read with great interest the article "Efficacy of catheter ablation for premature ventricular contractions (PVC) in arrhythmogenic right ventricular cardiomyopathy (ARVC)" by Assis et al 1 and thanks for the authors for their contribution to the literature. We would like to point out a few points to be considered about their study.…”

Analysis of digitalized ECG signals based on artificial intelligence and spectral analysis methods specialized in ARVC

“…Indicatively, in Reference 19 the authors compare the characteristics of P waves in patients with ARVC, 10 years before and up to 15 years after the diagnosis of the disease, concluding that initial ARVC progression is accompanied by P wave flattening while later stages are characterized by increased prevalence of PTF‐V1. Moreover, the authors in Reference 20 examine the role of premature ventricular ablation in patients with ARVC, while 21 describes the symptoms and abnormalities encountered in women suffering from this disease. Finally, in Reference 22 the prevalence of left ventricular (LV) involvement and imaging features of LV phenotype in patients with ARVC is highlighted, while the authors in Reference 23 investigate the existence of disease‐associated microRNAs in pericardial fluid that are potentially linked to ARVC pathogenesis.…”