Catheter ablation of symptomatic idiopathic ventricular arrhythmias

Abstract

AimsThis study was designed to gain insight into the patient characteristics, results and possible complications of ablation procedures for symptomatic idiopathic premature ventricular complexes (PVC) and idiopathic ventricular tachycardia (VT).MethodsData were collected from all patients who underwent radiofrequency catheter ablation for symptomatic PVCs and idiopathic VT in the Catharina Hospital between 1 January 2011 and 31 December 2015. The procedural endpoint was elimination or non-inducibility of the clinical arrhythmia. Successful sustained ablation was defined as the persistent elimination of at least 80% of the PVCs or the absence of VTs at follow-up. In case of suspected PVC-induced cardiomyopathy, the systolic left ventricular function was reassessed 3 months post procedure.ResultsOur cohort consisted of 131 patients who underwent one or more ablation procedures; 99 because of symptomatic premature ventricular complexes, 32 because of idiopathic VT. In total 147 procedures were performed. The procedural ablation success rate was 89%. Successful sustained ablation rate was 82%. Eighteen (13.2%) patients had suspected PVC-induced cardiomyopathy. In 15 of them (83%), successful sustained ablation was achieved and the left ventricular ejection fraction improved from a mean of 39% (±8.8) to 55.4% (±8.1). Most arrhythmias originated from the right ventricular outflow tract (60%) or aortic cusps (13%). Complications included three tamponades.ConclusionCatheter ablation therapy for idiopathic ventricular arrhythmias is very effective with a sustained success rate of 82%. In patients with PVC-induced cardiomyopathy, it leads to improvement of systolic left ventricular function. However, risk for complications is not negligible, even in experienced hands.

Asymptomatic cardiac tumour with premature ventricular contraction in an athlete: case report

“…2 The most common origins of PVC are the ventricular outflow tracts. 4 However, on cardiac screening for competitive sports, inferior originated PVC was detected in our patient. Like these atypical originated PVCs when detected, it should be kept in mind that there may be a structural anomaly like mass.…”

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

“…Antiarrhythmic medications can suppress PVCs, but associated side effects often limit their long‐term use 3 . In contrast, radiofrequency catheter ablation of idiopathic PVCs is successful in 70−85% of patients depending on the location of the arrhythmic focus, number of PVC morphologies, ablation technique used, and whether antiarrhythmic medications are used after ablation 4,5 . Given the low rate of complications and the superiority of catheter ablation to pharmacotherapy in patients with idiopathic PVCs, 4,6,7 it is the first‐line therapy in many patients with frequent and/or symptomatic PVCs 8 …”

The effect of idiopathic premature ventricular complexes on left ventricular ejection fraction

“…In the literature, it was suggested that PVCs can lead to the deterioration of left ventricular (LV) function and subsequent LV dilatation which is defined as PVC induced cardiomyopathy (PVC‐CMP) (Agarwal et al, ; Nguyen et al, ; Niwano et al, ). Recent studies demonstrated that PVC‐CMP could be reversed upon the suppression of PVCs by antiarrhythmic drugs (AAD) or catheter ablation (Duffee, Shen, & Smith, ; Oomen, Dekker, & Meijer, ; Yarlagadda et al, ). Also, it was reported that PVC‐CMP was re‐observed in patients with recurrence of PVC after catheter ablation (Baser et al, ).…”

“…Recent studies demonstrated that PVC-CMP could be reversed upon the suppression of PVCs by antiarrhythmic drugs (AAD) or catheter ablation (Duffee, Shen, & Smith, 1998;Oomen, Dekker, & Meijer, 2018;Yarlagadda et al, 2005). Also, it was reported that PVC-CMP was re-observed in patients with recurrence of PVC after catheter ablation (Baser et al, 2015).…”