Long-Term Follow-Up of Catheter Ablation for Premature Ventricular Complexes in the Modern Era: The Importance of Localization and Substrate

Abstract

Background: Large-scale studies evaluating long-term recurrence rates in both idiopathic and non-idiopathic PVC catheter ablation (CA) patients have not been reported. Objective: To evaluate the efficacy and safety of idiopathic and non-idiopathic PVC CA, investigating the predictors of acute and long-term efficacy. Methods: This retrospective multicentric study included 439 patients who underwent PVC CA at three institutions from April-2015 to December-2021. Clinical success at 6 months’ follow-up, defined as a reduction of at least 80% of the pre-procedural PVC burden, was deemed the primary outcome. The secondary aims of the study were: clinical success at the last available follow-up, predictors of arrhythmic recurrences at long-term follow-up, and safety outcomes. Results: The median age was 51 years, with 24.9% patients being affected suffering from structural heart disease. The median pre-procedural PVC burden was 20.1%. PVCs originating from the RVOT were the most common index PVC observed (29.1%), followed by coronary cusp (CC) and non-outflow tract (OT) LV PVCs (23.1% and 19.0%). The primary outcome at 6 months was reached in 85.1% cases, with a significant reduction in the 24 h% PVC burden (−91.4% [−83.4; −96.7], p < 0.001); long-term efficacy was observed in 82.1% of cases at almost 3-year follow-up. The presence of underlying structural heart disease and non-OT LV region origin (aHR 1.77 [1.07–2.93], p = 0.027 and aHR = 1.96 [1.22–3.14], p = 0.005) was independently associated with recurrences. Conclusion: CA of both idiopathic and non-idiopathic PVCs showed a very good acute and long-term procedural success rate, with an overall low complication. Predictors of arrhythmic recurrence at follow-up were underlying structural heart disease and non-OT LV origin.

Long-Term Outcomes of Catheter Ablation for Ventricular Arrhythmias: Comparing Techniques with and without Intracardiac Echocardiography - What Matters?

“…Idiopathic ventricular arrhythmias, such as PVCs and VT, commonly originate from OT, particularly RVOT. As substantiated by previous reports and corroborated by our data, CA for PVCs stemming from the RVOT had the highest success rate at around 90% and a low rate of complications 4,6 . For non-OT PVC origins, success rates were between 50-80%, with poorer outcomes observed from epicardial sites, aligning with our findings 4,6 .…”

“…As substantiated by previous reports and corroborated by our data, CA for PVCs stemming from the RVOT had the highest success rate at around 90% and a low rate of complications 4,6 . For non-OT PVC origins, success rates were between 50-80%, with poorer outcomes observed from epicardial sites, aligning with our findings 4,6 . PVC-induced cardiac dysfunction is considered a significant prognostic event for idiopathic ventricular arrhythmias 15 .…”

“…Clinically, long-term success rates are of immense concern. Factors affecting outcomes primarily include PVC origin and burden 4,6 , with RVOT-derived arrhythmias generally showing better prognosis and epicardial origins being associated with higher recurrence 4 . In our study, PVC origin was a principal determinant of ablation outcomes as well.…”

“…Approximately 80% of patients achieve long-term relief following CA, although the procedure entails a 4% risk of complications. Outcomes are typically less favorable for PVCs originating from non-outflow tract (non-OT) locations, and there is a significant need to improve the success rates of CA for these cases 3,4,6 . Intracardiac echocardiography (ICE) provides high-quality, real-time imaging of the heart and has been extensively adopted in both diagnostic and therapeutic cardiac interventions 7 .…”

Calidad de vida en pacientes con arritmias ventriculares idiopáticas tratados en el Instituto Nacional Cardiovascular - INCOR

“…La ablación 3D es un método terapéutico que presenta una baja tasa de recurrencia y alta eficacia 17 . Estos resultados se ven reflejados en una mejora significativa e incluso la eliminación de la sintomatología, especialmente en el grupo de pacientes que fueron a ablación 3D lo que permitiría mejorar la percepción de su calidad de vida relacionado a la salud, especialmente en la salud física y mental.…”