Chronic Frequent Premature Ventricular Complexes Originating From Right and Non-Right Ventricular Outflow Tracts Change in Left Ventricular Function After Radiofrequency Catheter Ablation

Abstract

SummaryFrequent premature ventricular complexes (PVCs) from the right ventricular outflow tract (RVOT) have recently been reported to be a cause of dilated cardiomyopathy. We studied the clinical impact of the elimination of PVCs from RVOT and non-RVOT.Thirty-six patients with symptomatic PVCs that were treated with radiofrequency catheter ablation (RFCA) were studied. The patients were assigned to one of two groups according to the origin of the PVCs (group I, RVOT-origin, n = 24; group II, non-RVOT-origin, n = 12) and observed for 10.5 ± 7.1 months.The burden of PVCs at baseline was 19.7 ± 10.6% and 18.7 ± 8.7% in group I and group II, respectively (P = 0.779). In group II, hypertension was more common (16.7% versus 58.3%, P = 0.020) and LV diastolic function was worse (Em, 8.7 ± 3.0 versus 6.4 ± 1.8 cm/second, P = 0.018). The LV end diastolic volume index (LVEDVI) decreased in both groups (59.7 ± 14.6 to 50.9 ± 9.6 mL/m 2 , P = 0.004 in group I; 60.0 ± 19.9 to 51.6 ± 12.4 mL/m 2 , P = 0.044 in group II), while the left atrial volume index (LAVI) decreased only in group I (36.7 ± 11.7 to 31.7 ± 10.0 mL/m 2 , P = 0.002 in group I; 35.6 ± 11.9 to 33.8 ± 10.3 mL/m 2 , P = 0.317 in group II). The left ventricular ejection fraction (LVEF) significantly improved in both groups (51.1 ± 6.6 to 59.8 ± 7.2 %, P < 0.01 in group I; 49.9 ± 6.9 to 59.0 ± 5.9 %, P < 0.01 in group II).RFCA of PVCs leads to a reduction of LV volume and improvement of LV systolic function regardless of the origin of the PVCs. Conversely, a non-RVOT-origin as well as an RVOT-origin of the PVCs can cause DCM-like changes in the left ventricle. (Int Heart J 2010; 51: 388-393)

Radiofrequency Catheter Ablation for the Treatment of Idiopathic Premature Ventricular Contractions Originating from the Right Ventricular Outflow Tract: A Systematic Review and Meta‐Analysis

“…A total of 14 articles were included in this systematic review. Characteristics of included studies are described in Table .…”

“…A total of 14 articles were identified for inclusion. Eleven manuscripts and three structured abstracts were included in this systematic review and meta‐analysis. One manuscript not published in English was included in the meta‐analyses since a structured abstract with pertinent results was available in English.…”

Peri‐operative ventricular bigeminy and cardiomyopathy in elective surgery

“…in 2000, it has a higher success rate in reversing underlying ventricular dysfunction than medical therapy alone . The origin of PVCs is important in determining the likelihood of successful treatment, with those originating from the right ventricular outflow tract more amenable to successful catheter ablation . A short PVC QRS duration is another independent predictor of the success of interventional management .…”

A Review of the Potential Pathogenicity and Management of Frequent Premature Ventricular Contractions

“…The localization of the PVC is not a major factor in development of cardiomyopathy . However, patients with fascicular PVCs seem to be protected because their ectopic focus is close to the natural conduction system and therefore does not cause dyssynchrony.…”