The safety of catheter ablation for premature ventricular contractions in patients without structural heart disease

Abstract

BackgroundPatients with frequent premature ventricular contractions (PVCs) are often symptomatic. Catheter ablation was usually indicated to eliminate symptoms in patients with PVCs-induced cardiomyopathy. Currently, PVCs-ablation is also applied for patients with PVCs and no structural heart diseases (SHD); however, the safety and efficacy of ablation in these patients remains unclear.MethodsIn this retrospective study, data from patients who underwent ablation for PVCs from January 2010 to December 2016 at our hospital was retrieved. Predictors of complications and acute procedural success were evaluated.ResultsA total of 1231 patients (mean age 47.8 ± 16.8 years, 59% female) were included. The overall complication rate was 2.7%, and the most common complication was hydropericardium. Two ablation-related mortalities occurred. One patient died of coronary artery injury during the procedure and the other died from infectious endocarditis. Location (left ventricle and epicardium) was the main predictor of complications, with right ventricular outflow tract (RVOT) predicting fewer complications. The acute procedural success rate was 94.1% in all patients. The main predictor of acute procedural success was RVOT origin, while an epicardial origin was a predictor of procedural failure.ConclusionLocations of left ventricle and epicardium were predictors of procedural complications for patients with PVCs. Therefore, ablation is not recommended in these patients. For other origins of PVCs, particularly RVOT origin, ablation is a safety and effective treatment.

Role of the notched unipolar electrogram in guiding catheter ablation of frequent premature ventricular contractions originating from the ventricular outflow tract

“…Regarding catheter ablation of VOT-PVCs, the acute success rate in published series ranged from 77% to 97%, while the long-term success rate ranged from 77% to 83%. [13][14][15] The results of the current study were similar to the overall success of ablation for PVCs reported in the literature. [13][14][15] In the group with acute procedural success, 16 patients still had sporadic PVCs within the first 24-h post-ablation.…”

“…[13][14][15] The results of the current study were similar to the overall success of ablation for PVCs reported in the literature. [13][14][15] In the group with acute procedural success, 16 patients still had sporadic PVCs within the first 24-h post-ablation. These patients might have deeper PVC origins than patients that achieved total elimination of PVCs, resulting in a hindered radiofrequency energy delivery to the PVC origin during catheter ablation.…”

Pulmonary Cusp Positioning of a Right Ventricular Outflow Tract Ventricular Tachycardia in a Pediatric Patient Identified Using Intracardiac Echocardiography

“…Published success rates of RF ablation for VPBs from the RVOT have been excellent and range from 93% to 97.1% [5][6][7] ; however, very few pediatric patients were included in these studies. Further, complication rates published from these investigations focused on acute complications like acute cardiac events or those related to vascular access.…”

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

“…RFCA allowed a significant decrease in PVCs in the LV. 24 Atrioventricular conduction block occurred in 2 patients. In patients with arrhythmias originating from high risk regions conservative treatment may be the option of choice.…”