Catheter ablation of premature ventricular complexes with low intraprocedural burden guided exclusively by pace‐mapping

Shirai, Yoshio; Liang, Jackson J.; Supple, Gregory E.; Riley, Michael P.; García, Fermin C.; Lin, David; Callans, David J.; Marchlinski, Francis E.; Frankel, David S.; Schaller, Robert D.

doi:10.1111/jce.14127

Cited by 22 publications

(18 citation statements)

References 32 publications

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“…This is not surprising, as more challenging ablation of deep septal, papillary or epicardial PVCs would be expected to require more RF and fluoroscopy time, as has been shown previously. 2,3,8 In our study, RV compared with LV sites were also more likely to be associated with long term success, consistent with previous studies. Latchemsetty et al 3 reported that highest long-term success rates were achieved with RVOT ablation (82%), and lowest with LV papillary muscle ablation (60%).…”

supporting

confidence: 92%

“…Radiofrequency catheter ablation (RFCA) is an effective treatment for symptomatic, idiopathic premature ventricular complexes (PVCs) and can improve cardiac function in patients with PVC mediated cardiomyopathy. 1,2 Activation mapping is the preferred strategy to localize the site of origin and guide successful ablation. Short-term outcomes in patients undergoing RFCA in the contemporary era are excellent with a large multicenter retrospective cohort study demonstrating an overall acute success rate of 84% (range, 67%-93%).…”

Section: Introductionmentioning

confidence: 99%

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Predictors of long‐term success after catheter ablation of premature ventricular complexes

Voskoboinik

Lee

et al. 2021

Cardiovasc electrophysiol

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Introduction: Some patients have late recurrence after acutely successful radiofrequency catheter ablation (RFCA) of premature ventricular complexes (PVCs). The aim of this study was to evaluate predictors of long-term success following acutely successful PVC RFCA. Methods:We identified consecutive patients at our institution with frequent PVCs undergoing RFCA and reviewed procedural data and medical records. Acute success was defined as elimination of targeted PVCs for at least 30-min after RFCA. Longterm success was defined as absence of targeted PVCs during all follow-up visits and PVC-burden <5% on follow-up monitoring.Results: Among 241 patients (mean age 57 ± 15 years, 58% male), 161 (66.8%) had long-term success with median follow-up of 17.7 (IQR, 12.2-29.8) months. Unadjusted predictors of late PVC recurrence were increasing age, diabetes mellitus and alcohol use, while female-sex, shorter ablation-time, right ventricular PVCorigin, single PVC morphology, and earliest bipolar activation ≥24 ms pre-QRS were predictors of long-term success. In multivariate-analysis, female-sex, single-PVC morphology and earliest-onset of PVC ≥ 24 ms pre-QRS were independent predictors for long-term success. The positive-predictive value of earliest-bipolar onset of PVC ≥ 24 ms pre-QRS for long-term success was 0.77 (p < .001). Negativepredictive value of PVC < 15 ms pre-QRS for long-term success was 0.86 (p = .003), suggesting that RFCA when the bipolar electrogram preceded QRS by <15 ms was unlikely to result in long-term success.Conclusions: Female-sex, single-PVC morphology, and earliest-onset of bipolar electrogram ≥24 ms pre-QRS were multivariable predictors of long-term success in patients with PVCs undergoing RFCA. RFCA at sites with local onset <15 ms pre-QRS are unlikely to be successful.

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supporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Predictors of long‐term success after catheter ablation of premature ventricular complexes

Voskoboinik

Lee

et al. 2021

Cardiovasc electrophysiol

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“…Previous studies using primarily pace mapping to guide ablation of idiopathic VA Shirai and colleagues 5 recently described a similar PM approach in 24 patients with low intraprocedural burden of PVCs originating from any ventricular site. Patients included were similar in demographics to our study, the majority with a diagnosis of idiopathic PVCs and 2 patients with impaired LV ejection fraction ,50%, secondary to PVC-induced cardiomyopathy.…”

Section: Discussionmentioning

confidence: 99%

“…Although results are encouraging, these studies are limited by a small number of patients, with reported freedom from clinical VA between 79% and 100%, during medium-term follow-up. 4,5 In this study we sought to compare outcomes among patients with low intraprocedural burden of idiopathic outflow tract VA who received ablation guided by a PM approach vs patients with frequent intraprocedural idiopathic outflow tract VA undergoing standard activation-guided ablation (non-PM). We hypothesized that the 2 techniques would have comparable outcomes.…”

Section: Introductionmentioning

confidence: 99%

Catheter ablation of idiopathic outflow tract ventricular arrhythmias with low intraprocedural burden guided by pace mapping

et al. 2021

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BACKGROUND There are limited data comparing ablation outcomes in patients with low intraprocedural burden of ventricular arrhythmias (VA) undergoing a pace mapping (PM)-guided strategy vs those with high burden guided by standard activation mapping strategy (non-PM).OBJECTIVE We sought to determine if catheter ablation-guided by PM of low-intraprocedural-burden idiopathic outflow tract VA would be noninferior compared to non-PM-guided ablation.METHODS Outcomes of catheter ablation of idiopathic outflow tract VA in 22 patients with a low burden of intraprocedural VA using PM-guided ablation were compared to 44 patients with a high burden of intraprocedural VA undergoing ablation using standard techniques.RESULTS Sixty-six patients were included (age 46.5 6 14.8 years; 68% female, left ventricular ejection fraction 59% 6 5%). Within the PM group, 24-hour preprocedure premature ventricular complex (PVC) burden was 9.5% (interquartile range [IQR] 4%-13.8%), number of pace maps 33.6 6 18.5, surface area of 95% pace map correlation 1.9 6 1.2 cm 2 , with best pace map correlation 96% (IQR 92%-97%). Within the non-PM group, 24-hour preprocedure PVC burden was 13.5% (IQR 6.6%-30%), earliest activation time -33.7 6 9.9 ms. Procedural duration, general anesthesia administration, fluoroscopy dose, and complications were all comparable. Following final procedure, 24-hour VA burden (PM 0% [IQR 0-2.4%] vs non-PM 0% [IQR 0-4.2%], P 5 .98), along with VA-free survival at 6-month follow-up (PM 77% vs non-PM 71%, P 5 .77), were both comparable.CONCLUSION In patients with low intraprocedural burden of outflow tract VA, PM-guided catheter ablation can accurately identify the VA site of origin, leading to outcomes comparable to those achieved with standard ablation techniques.

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“…Second, in patients with infrequent PVCs at the beginning of the procedure, infusion of isoproterenol or low‐dose adrenalin can often induce a sufficient number of PVCs for reliable activation mapping and ablation 17 . Third, pace‐mapping during sinus rhythm in addition to activation mapping, can be particularly useful in ablation procedures with infrequent PVCs 18 . However, pace mapping might be adequate for PVCs in some locations (RVOT), but not in others (e.g., aortic cusps, within the LV superior septum, etc.).…”

Section: Discussionmentioning

confidence: 99%

Pre‐procedural arrhythmia burden and the outcome of catheter ablation of idiopathic premature ventricular complexes

Asatryan

Seiler

Bourquin

et al. 2021

Pacing Clinical Electrophis

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Background Radiofrequency catheter ablation of idiopathic premature ventricular complexes (PVCs) is an effective method for eliminating symptoms and preventing/reversing arrhythmia‐induced cardiomyopathy. One reason for procedural failure is low PVC frequency during the procedure. We aimed to investigate the relation between pre‐procedural PVC burden and outcome of idiopathic PVC catheter ablation. Methods Patients who underwent idiopathic PVC ablation between 2013 and 2019 at two tertiary referral centers were retrospectively included. All procedures were performed using irrigated‐tip ablation catheters and a 3D electro‐anatomical mapping system. Sustained ablation success was defined as a ≥80% reduction of pre‐procedural PVC burden determined by 24h‐Holter at follow‐up. Results Overall, 254 patients (median age 54 years [IQR 42–64]; 47% male) were enrolled. The median pre‐ablation PVC‐burden was 22% (IQR 11–31%), which was reduced to a post‐ablation PVC burden of 0.3% (IQR 0–4%) after a median of 90 days. Sustained ablation success was achieved in 182 patients (72%). Pre‐procedural PVC burden did not differ between patients with sustained ablation success and recurrence during follow‐up (median 21% vs. 22%, p = .76). When assessed in pre‐ablation PVC‐burden groups of ≤5%, 6–15%, 16–30%, and ≥31%, sustained ablation success was achieved in 67%, 75%, 71%, and 72%, respectively, with no significant difference (p = .89). Sustained ablation outcome for PVC‐burden ≤5% versus >5% showed no difference either (67% vs. 72%, p = .52). Conclusions Pre‐procedural Holter‐determined PVC burden does not predict the outcome of idiopathic PVC ablation. Thus, catheter ablation may be a reasonable first choice also for patients with symptomatic yet rare PVCs.

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Catheter ablation of premature ventricular complexes with low intraprocedural burden guided exclusively by pace‐mapping

Cited by 22 publications

References 32 publications

Predictors of long‐term success after catheter ablation of premature ventricular complexes

Predictors of long‐term success after catheter ablation of premature ventricular complexes

Catheter ablation of idiopathic outflow tract ventricular arrhythmias with low intraprocedural burden guided by pace mapping

Pre‐procedural arrhythmia burden and the outcome of catheter ablation of idiopathic premature ventricular complexes

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