Multicenter outcomes for catheter ablation of idiopathic premature ventricular complexes

Rakesh Latchamsetty, Miki Yokokawa, Fred Morady, Hyungjin Myra Kim, Shibu Mathew, Roland Tilz, Karl Heinz Kuck, Koichi Nagashima, Usha Tedrow, William Gregory Stevenson, Ricky Yu, Roderick Tung, Kalyanam Shivkumar, Jean Francois Sarrazin, Arash Arya, Gerhard Hindricks, Rama Vunnam, Timm Dickfeld, Emile G. Daoud, Nishaki M. OzaFrank Bogun

Research output: Contribution to journalArticle

104 Scopus citations

Abstract

Objectives This study reports multicenter outcomes and complications for catheter ablation of premature ventricular complexes (PVCs) and investigates predictors of procedural success, as well as development of PVC-induced cardiomyopathy. Background Catheter ablation of frequent idiopathic PVCs is used to eliminate symptoms and treat PVC-induced cardiomyopathy. Large-scale multicenter outcomes and complication rates have not been reported. Methods This retrospective cohort study included 1,185 patients (55% female; mean age 52 ± 15 years; mean ejection fraction 55 ± 10%; mean PVC burden 20 ± 13%) who underwent catheter ablation for idiopathic PVCs at 8 centers between 2004 and 2013. The following factors were evaluated: patient demographics, procedural characteristics, complication rates, and clinical outcomes. Results Acute procedural success was achieved in 84% of patients. In centers at which patients were followed up routinely with post-ablation Holter monitoring, continued success at clinical follow-up without use of antiarrhythmic drugs was 71%. Including the use of antiarrhythmic medications, the success rate at a mean of 1.9 years of follow-up was 85%. In a multivariate analysis, the significant predictors of acute success were PVC location and number of distinct PVC configurations (p < 0.03). The only significant predictor of continued success at clinical follow-up was a right ventricular outflow tract PVC location (p < 0.01). In 245 patients (21%) with PVC-induced cardiomyopathy, the mean ejection fraction improved from 38% to 50% (p < 0.01) after ablation. Independent predictors for development of PVC-induced cardiomyopathy were male gender, PVC burden, lack of symptoms, and epicardial PVC origin (p < 0.05). The overall complication rate was 5.2% (2.4% major complications and 2.8% minor complications), and complications were most commonly related to vascular access (2.8%). There was no procedure-related mortality. Conclusions 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.

Original languageEnglish (US)
Pages (from-to)116-123
Number of pages8
JournalJACC: Clinical Electrophysiology
Volume1
Issue number3
DOIs
StatePublished - Jun 2015

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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    Latchamsetty, R., Yokokawa, M., Morady, F., Kim, H. M., Mathew, S., Tilz, R., Kuck, K. H., Nagashima, K., Tedrow, U., Stevenson, W. G., Yu, R., Tung, R., Shivkumar, K., Sarrazin, J. F., Arya, A., Hindricks, G., Vunnam, R., Dickfeld, T., Daoud, E. G., ... Bogun, F. (2015). Multicenter outcomes for catheter ablation of idiopathic premature ventricular complexes. JACC: Clinical Electrophysiology, 1(3), 116-123. https://doi.org/10.1016/j.jacep.2015.04.005