The effect of radiofrequency catheter ablation of frequent premature ventricular complexes and arrhythmia burden on left ventricular function

Abstract

A b s t r a c tBackground: Frequent premature ventricular complexes (PVC) are related to reversible tachycardia-induced cardiomyopathy. However, the role of arrhythmia burden on the outcome of the catheter ablation has not been fully recognised. Aim:The aim of this study was to assess the effect of catheter ablation and PVC burden in patients with and without structural heart disease (SHD) on left ventricular ejection fraction (LVEF). Methods:Transthoracic echocardiography was done before and six months after radiofrequency catheter ablation in 109 consecutive patients (61 men, age 55 ± 17 years) with frequent PVCs. Sixty-five (59.6%) patients had underlying SHD. Results:The catheter ablation procedure was successful in 93 (85.3%) patients. Baseline PVC burden was higher in patients with SHD (22,267 ± 12,934) compared to those without concomitant SHD (15,546 ± 7888), p = 0.005. Nevertheless, patients with LVEF ≤ 50% at baseline presented greater LVEF recovery (from 44% to 56%) than those with LVEF > 50% at baseline after catheter ablation. In both groups, the LVEF improved (p < 0.001); however, no difference was observed between patients with SHD (5.7% ± 1.37%) and without (4.6% ± 0.96%) SHD; p = 0.89. PVC burden was higher in patients with (24,350 ± 2776 PVC/day) compared to those without (17,588 ± 1970 PVC/day) improvement of LVEF. In multivariate regression analysis PVC burden > 20,000/day (but not age, p = 0.95; gender, p = 0.89; presence of SHD, p = 0.53; QRS complex width of the treated PVC, p = 0.21, LVEF before ablation, p = 0.19; and site of origin, p = 47) predicted improvement in LVEF after successful catheter ablation (odds ratio: 3.53; 95% confidence interval: 1.15-10.75; p = 0.023). Conclusions:Catheter ablation of frequent PVCs improves left ventricular function in multivariate analysis predicted improvement of LVEF within six months after the successful catheter ablation procedure in patients with PVC burden exceeding 20,000/24 h.

Reversal of premature ventricular complexes induced cardiomyopathy. Influence of concomitant structural heart disease

“…Very few studies have reported relevant data where cut off values of 13%, or >20000/24 h predicted >5% increase in LVEF after RF ablation. This finding was consistent among patients with resting normal EF or those with LV dysfunction in absence or presence of SHD like in the current study 17, 18…”

Left Atrial Function Is Improved in Short-Term Follow-Up after Catheter Ablation of Outflow Tract Premature Ventricular Complexes

“…The efficacy of RFCA in the management of LV systolic function was questioned in several trials, and a favorable effect of this modality on LV as well as RV systolic function was demonstrated [3,20]. Two important meta-analyses were conducted on these trials.…”

Does the origin of ablated premature ventricular contractions determine the level of left ventricular function improvement?

“…Some studies confirm the relation between PVC burden (10%-20%) and the rate of LVEF positive reversal. [16][17][18][19] In patients with successful RFCA therapy, even a 14% increase in LVEF and a 5-mm mean decrease of LVEDd was observed. In patients with preexisting LV dysfunction, the improvement was not as great.…”

“…On the other hand, reduction in LVEDd was significant in the OT group: from 54 (9) to 51 (12) (P = 0.015). Patients in the OT group had an increased ejection fraction after ablation than before (52% [12] vs 58% [13]; P <0.001) in comparison with the VENT group (47% [16] vs 50% [15]; P = 0.08; FIGURE 3), despite higher baseline LVEF values before the procedure in the OT group than the VENT group (mean [SD], 52 [12] vs 47 [16]; P = 0.001).…”

“…RESULTS A total of 110 patients (mean [SD] age, 55 [16] years; female sex, 48%) with frequent PVCs were referred for RFCA of symptomatic ventricular arrhythmia. All patients underwent 24-hour Holter monitoring and echocardiography before the procedure and 6 months after.…”