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

Im, Sung Il; Voskoboinik, Aleksandr; Lee, Adam F.; Higuchi, Satoshi; Moss, Joshua D.; Hsia, Henry H.; Tseng, Zian H.; Lee, Randall; Marcus, Gregory M.; Vedantham, Vasanth; Scheinman, Melvin M.; Lee, Byron; Park, Kyoung-Min; Gerstenfeld, Edward P.

doi:10.1111/jce.15114

Cited by 11 publications

(15 citation statements)

References 11 publications

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“…Indeed, when analyzing predictors of adverse outcome in patients with frequent PVCs, in this large cohort study from Voskoboinik et al [ 11 ], patients with structural heart disease were excluded from both validation cohorts. Moreover, Im et al [ 12 ] showed that right ventricular PVC was among the unadjusted predictors of late PVC recurrence; however, the multivariate analysis failed to show that PVC site of origin was among the independent predictors for long-term success. Furthermore, patients with a history of structural heart disease were excluded.…”

Section: Discussionmentioning

confidence: 99%

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

Gulletta¹,

Gasperetti

Schiavone

et al. 2022

JCM

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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.

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Section: Discussionmentioning

confidence: 99%

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

Gulletta¹,

Gasperetti

Schiavone

et al. 2022

JCM

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“…In a focal ventricular arrythmia, the site of earliest activation is targeted for ablation, with local EGMs >24 ms prior to the earliest activation of the surface QRS a predictor of long-term success. [ 64 ] Characteristically, the local EGM may also display a reverse polarity pattern on the distal and proximal bipoles of the ablation catheter, often with low amplitude initial components. [ 65 ] However, this finding is not specific, and pseudo-focal patterns may also be present in deep substrate.…”

Section: Mapping During Ventricular Tachycardiamentioning

confidence: 99%

Contemporary Management of Complex Ventricular Arrhythmias

Wiles

Waight

et al. 2022

Arrhythm Electrophysiol Rev

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Percutaneous catheter ablation is an effective and safe therapy that can eliminate ventricular tachycardia, reducing the risks of both recurrent arrhythmia and shock therapies from a defibrillator. Successful ablation requires accurate identification of arrhythmic substrate and the effective delivery of energy to the targeted tissue. A thorough pre-procedural assessment is needed before considered 3D electroanatomical mapping can be performed. In contemporary practice, this must combine traditional electrophysiological techniques, such as activation and entrainment mapping, with more novel physiological mapping techniques for which there is an ever-increasing evidence base. Novel techniques to maximise energy delivery to the tissue must also be considered and balanced against their associated risks of complication. This review provides a comprehensive appraisal of contemporary practice and the evidence base that supports recent developments in mapping and ablation, while also considering potential future developments in the field.

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“…Catheter ablation has been established as an important treatment strategy for idiopathic premature ventricular complexes (PVCs). Success rates with PVC ablation can range from 50 to > 90%, and can vary based on PVC sites of origin, electrophysiological characteristics, ablation techniques, as well as operator experience [1]. Among the different reported locations, PVCs originating from the ventricular outflow tract (OT-PVCs) are the most commonly seen, and similarly have been the most studied [2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Rationale and study design for empirical additional lesions for premature ventricular complex from the outflow tract: a multi-center, prospective randomized trial (EASE-PVC study)

Wang

Xiao

et al. 2022

J Interv Card Electrophysiol

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Background Late recurrence after ablation remains a significant issue in patients with premature ventricular complexes (PVCs) who undergo catheter ablation. In this study, we aimed to test the hypothesis that empirical additional ablation (EAA) would improve the long-term control of PVCs from outflow tracts (OT-PVCs) compared with the approach of limited single point ablation at the assumptive location. Methods EASE-PVC study (ChiCTR2200055340) is a prospective multi-center, randomized, and controlled trial designed to assess the effectiveness and safety of empirical additional ablation in patients with OT-PVCs. After successful elimination of OT-PVCs, the patients will be randomized into two groups. In patients randomized to the EAA group, additional lesion applications at sites surrounding the successful ablation site will be delivered empirically. For patients randomized to the control group, no additional empiric ablation will be performed around the successful ablation site. The primary endpoint will be freedom from PVC recurrence at 3 months following ablation, without antiarrhythmic drug therapy. Conclusions The EASE-PVC study is designed to compare the effectiveness and safety of two different strategies for ablation in patients with OT-PVCs, namely empirical additional ablation strategy versus conventional single point ablation strategy. This prospective, multi-center, and randomized controlled trial, with comparative data evaluating procedural and long-term follow-up results, aims to elucidate the superiority of empirical additional ablation for the long-term control of OT-PVCs compared with the traditional single point ablation strategy. Clinical trial registration Chinese Clinical Trials Registry Identifier: ChiCTR2200055340.

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

Cited by 11 publications

References 11 publications

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

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

Contemporary Management of Complex Ventricular Arrhythmias

Rationale and study design for empirical additional lesions for premature ventricular complex from the outflow tract: a multi-center, prospective randomized trial (EASE-PVC study)

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