Ablation of frequent PVC in patients meeting criteria for primary prevention ICD implant: Safety of withholding the implant

Abstract

In patients with frequent PVC and PP-ICD indication, ablation improves LVEF and, in most cases, allows removal of the indication. Withholding the ICD and reevaluating within 6 months of ablation seems to be a safe and appropriate strategy.

Ventricular arrhythmia in heart failure patients with reduced ejection fraction and central sleep apnoea

“…Investigators were blinded with respect to clinical data and only had access to the ECG channel and the pre-scored PSG sleep stages. High and very high burden of ventricular arrhythmia was defined as PVCs>30·h −1 and >4% PVCs of total beats or >10 000 PVCs/24 h, respectively [ 2 – 7 ] (see online supplementary material for more details). In addition, a subset analysis (n=19, supplementary figure S1 ) was performed to analyse the occurrence of PVCs·h −1 in sleep stage N2 in episodes with and without CSR [ 15 , 22 ] (see online supplementary material for more details).…”

“…In addition, a high burden of ventricular arrhythmia (>30 premature ventricular complexes (PVCs) per hour) and a very high burden of ventricular arrhythmia (PVCs >4% of total beats or >10 000 PVCs/24 h) have been linked to the occurrence of higher grade ventricular arrhythmias ( e.g. (non-)sustained ventricular tachycardias) [ 1 ], impaired left ventricular systolic function [ 2 – 4 ] and higher mortality [ 4 – 7 ].…”

JCS/JHRS 2019 guideline on non‐pharmacotherapy of cardiac arrhythmias

“…It has been also reported that ablation can improve cardiac function in patients with frequent PVCs with structural heart disease. 1143 , 1144 , 1145 …”

Empiric ablation of asymptomatic PVCs when there is greater than 20% burden but normal left ventricular function—An argument in support of catheter ablation

“…After successful ablation of the PVCs, the LVEF will frequently improve, with a mean improvement of 10%–15%. 1 , 24 , 28 , 29 , 30 , 31 While the recovery of the LVEF can be gratifying to observe, the results can be disconcerting if a patient with previously normal LV systolic function does not achieve complete recovery of the LVEF. Animal models for PVC cardiomyopathy have shown that ultrastructural changes of biventricular myocardial fibrosis, derangements in calcium handling, and sympathetic neural remodeling may contribute to an accelerated pattern of PVC cardiomyopathy development in the future with a recurrent arrhythmia.…”