David Hamon1, Guillaume Abehsira2, Kai Gu3, Albert Liu4, Marie Blaye-Felice Sadron5, Sophie Billet5, Thomas Kambur6, Mohammed Amer Swid4, Noel G Boyle4, Gopi Dandamudi6, Philippe Maury5, Minglong Chen3, John M Miller6, Nicolas Lellouche2, Kalyanam Shivkumar4, Jason S Bradfield7. 1. UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, California; AP-HP, University Hospital Henri Mondor, Department of Cardiology, Creteil, France. Electronic address: david.a.hamon@gmail.com. 2. AP-HP, University Hospital Henri Mondor, Department of Cardiology, Creteil, France. 3. Division of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China. 4. UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, California. 5. University Hospital Rangueil, Department of Cardiology, Toulouse, France. 6. Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, Indiana. 7. UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, California. Electronic address: JBradfield@mednet.ucla.edu.
Abstract
BACKGROUND: Infrequent intraprocedural premature ventricular complexes (PVCs) may impede radiofrequency catheter ablation (RFA) outcome, and pharmacologic induction is unpredictable. OBJECTIVE: The purpose of this study was to determine whether PVC circadian variation could help predict drug response. METHODS: Consecutive patients referred for RFA with detailed Holter monitoring and frequent monomorphic PVCs were included. Patients were divided into 3 groups based on hourly PVC count relationship to corresponding mean heart rate (HR) during each of the 24 hours on Holter: fast-HR-dependent PVC (F-HR-PVC) type for a positive correlation (Pearson, P <.05), slow-HR-dependent PVC (S-HR-PVC) type for a negative correlation, and independent-HR-PVC (I-HR-PVC) when no correlation was found. RESULTS: Fifty-one of the 101 patients (50.5%) had F-HR-PVC, 39.6% I-HR-PVC, and 9.9% S-HR-PVC; 30.7% had infrequent intraprocedural PVC requiring drug infusion. The best predictor of infrequent PVC was number of hours with PVC count <120/h on Holter (area under the curve 0.80, sensitivity 83.9%, specificity 74.3%, for ≥2 h). Only F-HR-PVC patients responded to isoproterenol. Isoproterenol washout or phenylephrine infusion was successful for the 3 S-HR-PVC patients, and no drug could increase PVC frequency in the 12 I-HR-PVC patients. Long-term RFA success rate in patients with frequent PVCs at baseline (82.9%) was similar to those with infrequent PVC who responded to a drug (77.8%; P = .732) but significantly higher than for those who did not respond to any drug (15.4%; P <.0001). CONCLUSION: A simple analysis of Holter PVC circadian variability provides incremental value to guide pharmacologic induction of PVCs during RFA and predict outcome. Patients with infrequent I-HR-PVC had the least successful outcomes from RF ablation.
BACKGROUND: Infrequent intraprocedural premature ventricular complexes (PVCs) may impede radiofrequency catheter ablation (RFA) outcome, and pharmacologic induction is unpredictable. OBJECTIVE: The purpose of this study was to determine whether PVC circadian variation could help predict drug response. METHODS: Consecutive patients referred for RFA with detailed Holter monitoring and frequent monomorphic PVCs were included. Patients were divided into 3 groups based on hourly PVC count relationship to corresponding mean heart rate (HR) during each of the 24 hours on Holter: fast-HR-dependent PVC (F-HR-PVC) type for a positive correlation (Pearson, P <.05), slow-HR-dependent PVC (S-HR-PVC) type for a negative correlation, and independent-HR-PVC (I-HR-PVC) when no correlation was found. RESULTS: Fifty-one of the 101 patients (50.5%) had F-HR-PVC, 39.6% I-HR-PVC, and 9.9% S-HR-PVC; 30.7% had infrequent intraprocedural PVC requiring drug infusion. The best predictor of infrequent PVC was number of hours with PVC count <120/h on Holter (area under the curve 0.80, sensitivity 83.9%, specificity 74.3%, for ≥2 h). Only F-HR-PVCpatients responded to isoproterenol. Isoproterenol washout or phenylephrine infusion was successful for the 3 S-HR-PVC patients, and no drug could increase PVC frequency in the 12 I-HR-PVCpatients. Long-term RFA success rate in patients with frequent PVCs at baseline (82.9%) was similar to those with infrequent PVC who responded to a drug (77.8%; P = .732) but significantly higher than for those who did not respond to any drug (15.4%; P <.0001). CONCLUSION: A simple analysis of Holter PVC circadian variability provides incremental value to guide pharmacologic induction of PVCs during RFA and predict outcome. Patients with infrequent I-HR-PVC had the least successful outcomes from RF ablation.
Authors: Finn Akerström; Marta Pachón; José B Martínez-Ferrer; Javier Alzueta; Luisa Pérez; Ignacio Fernández Lozano; Anibal Rodríguez; Miguel A Arias Journal: Indian Pacing Electrophysiol J Date: 2020-03-09