Multicenter Outcomes for Catheter Ablation of Idiopathic Premature Ventricular Complexes

Abstract

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.

Catheter Ablation of Idiopathic Ventricular Arrhythmias Arising From the Cardiac Outflow Tracts – Recent Insights and Techniques for the Successful Treatment of Common and Challenging Cases –

“…3- 7 Recently, a large-scale multicenter report of outcomes after RFCA of idiopathic PVC found a 84% acute success rate and a 71% long-term success rate after a mean follow-up of 20 months. 8 We strongly believe that the success rate with newly developed techniques should be very high in very experienced centers (>95%). 9 Besides PVC, sustained and non-sustained monomorphic idiopathic VT also mainly originate from the cardiac OTs.…”

“…Furthermore, Drug therapy, mainly β-blockers and calcium-channel blockers, has limited effectiveness (25-50%) in arrhythmia suppression and although other antiarrhythmic drugs, such as flecainide, propafenone and amiodarone, have better clinical outcomes there are drug-related side effects. Therefore, RFCA is increasingly being used in these patients and because low complication rates as well as high success rates have been previously reported, 8 RFCA is recommended for highly symptomatic and drug-refractory patients with idiopathic VT. 2 Polymorphic VT triggered by short-coupled PVC always suggests the presence of any type of structural heart disease or an inherited arrhythmia syndrome and should be evaluated very carefully for underlying disease before consideration for RFCA. 8 …”

“…9 The success rate of ablation of LVOT-VA sites was previously reported to be lower (55-60%) without using antegrade/transseptal approaches. 3, 8 Rarely, it requires epicardial ablation via the GCV/AIV or subxiphoid puncture. 5, 34 Clinically, it may involve greater procedural complexity as well as periprocedural risk (stroke/coronary artery injury) compared with the RVOT.…”

“…32 A recent meta-analysis comparing RFCA of different PVC origin sites found an epicardial PVC origin to show the lowest RFCA success rate (67%) and a trend toward the highest procedural complication rate (4.2% of major complications). 8 The LV epicardial space is relatively large and includes the proximal left coronary artery and GCV. Using the cardiac venous system, ablation might result in a lower complication rate compared with the subxiphoid epicardial approach, because damage to the RV or extracardiac structures is less likely to occur.…”

Acute Cardiac Tamponade after Left Sided Premature Ventricular Contraction Ablation

“…The occurrence rate of cardiac tamponade at different PVC locations is similar and overall it is the highest with epicardial PVCs (4.2%). 6,7 Standard indications associated with a high success rate are: patients undergoing ablation for PVCs with typical indications such as frequent palpitation lasting longer than one year, monomorphic PVC, outflow tract location, >5000 PVC/24 hours on Holter-monitoring, without structural heart diseases or cardiac ischaemic history.…”