Mortality and morbidity reduction after frequent premature ventricular complexes ablation in patients with left ventricular systolic dysfunction

Abstract

Aims Ablation of frequent premature ventricular complexes (PVCs) improves left ventricular ejection fraction in patients with left ventricular (LV) systolic dysfunction. This study aims to evaluate the long-term hard outcomes and potential prognostic variables in this population. Methods and results Prospective multicentre study including 101 consecutive patients [56 ± 12 years old, 62 (61%) men] with LV systolic dysfunction and frequent PVCs who underwent PVC ablation before November 2015. The last evaluation performed was considered the long-term follow-up (LTFUP) evaluation. Mean follow-up was 34 ± 16 months (range 24–84 months). Ablation was successful in 95 (94%) patients. There was a significant reduction in the PVC burden from 21 ± 12% at baseline to 3.8 ± 6% at LTFUP, P < 0.001. Left ventricular ejection fraction improved from 32 ± 8% at baseline to 39 ± 12% at LTFUP (P < 0.001) and New York Heart Association class from 2.2 ± 0.6% to 1.3 ± 0.6% (P < 0.001). Brain natriuretic peptide levels decreased from 136 (78–321) to 68 (32–144) pg/mL (P = 0.007). Most of this improvement occurs during the first 6 months after ablation. Persistent abolition of at least 18 points of the baseline PVC burden was independently and inversely associated with the composite endpoint of cardiac mortality, cardiac transplantation, or hospitalization for heart failure during follow-up [hazard ratio 0.18 (0.05–0.66), P = 0.01]. Conclusion In patients with LV systolic dysfunction, ablation of frequent PVCs induces a significant improvement in functional, structural, and neurohormonal status, which persists at LTFUP. A sustained reduction in the baseline PVC burden is associated with a lower risk of cardiac mortality, cardiac transplantation, or hospitalization for heart failure during follow-up.

Aging Impairs Reverse Remodeling and Recovery of Ventricular Function after Isoproterenol-Induced Cardiomyopathy

“…However, two settings such as LVAD implant (with the consequent mechanical cardiac unloading) and ablation of premature ventricular complexes (PVC) in PVC-induced tachycardiomyopathy represent better clinical examples where reverse remodeling could occur after removal of the primary HF-inducing stimulus rather than in response to therapy. Clinical reports have suggested that both LVAD implant and PVC ablation are associated with recovery of LV dysfunction [ 5 , 30 , 31 , 32 ], and, at least for post-LVAD remodeling, partial regression of tissue fibrosis and gene expression [ 5 , 33 ], findings that are consistent with those observed in our young animals.…”

Catheter Ablation of Atrial Fibrillation in Patients With Functional Mitral Regurgitation and Left Ventricular Systolic Dysfunction

“…Further studies with larger sample sizes are needed to further evaluate the role of catheter ablation for AF in patients with functional MR and LVSD. Second, the precise LVEF cutoff regarding the definition for LVSD widely varies in the literature (10,20). Since normal LV systolic function in previous studies on atrial functional MR was usually defined as an LVEF ≥ 50% (1), we defined LVSD as an LVEF < 50%, as in a recent study (10), to discriminate atrial functional MR in the present study.…”

Integrated electrophysiology care for patients with heart failure: An envisioned future

“…22 PVCs and VT are also both contributors to HF and markers of HF exacerbation. 23 An integrated HF program would allow these arrhythmias to be dealt with more expeditiously. Some of these can be managed with simple CIED programming changes, such as atrial reactive antitachycardia pacing or increasing lower pacing rates to overdrive PVCs.…”