Rakesh Latchamsetty1, Miki Yokokawa2, Fred Morady2, Hyungjin Myra Kim3, Shibu Mathew4, Roland Tilz4, Karl-Heinz Kuck4, Koichi Nagashima5, Usha Tedrow5, William Gregory Stevenson5, Ricky Yu6, Roderick Tung6, Kalyanam Shivkumar6, Jean-Francois Sarrazin7, Arash Arya8, Gerhard Hindricks8, Rama Vunnam9, Timm Dickfeld9, Emile G Daoud10, Nishaki M Oza10, Frank Bogun2. 1. Division of Electrophysiology, Department of Medicine, University of Michigan, Ann Arbor, Michigan. Electronic address: rakeshl@umich.edu. 2. Division of Electrophysiology, Department of Medicine, University of Michigan, Ann Arbor, Michigan. 3. Biostatistics Department, School of Public Health, University of Michigan, Ann Arbor, Michigan. 4. Division of Electrophysiology, Department of Medicine, Asklepios Klinik St. Georg, Hamburg, Germany. 5. Division of Electrophysiology, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts. 6. Division of Electrophysiology, Department of Medicine, University of California, Los Angeles. 7. Division of Electrophysiology, Department of Medicine, Institut Universitaire de Cardiologie et Pneumologie de Quebec, Quebec, Canada. 8. Division of Electrophysiology, Department of Medicine, University Leipzig Heart Center, Leipzig, Germany. 9. Division of Electrophysiology, Department of Medicine, University of Maryland, Baltimore, Maryland. 10. Division of Electrophysiology, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio.
Abstract
OBJECTIVES: This study reports multicenter outcomes and complications for catheter ablation of premature ventricular complexes (PVCs) and investigates predictors of procedural success, as well as development of PVC-induced cardiomyopathy. BACKGROUND: Catheter ablation of frequent idiopathic PVCs is used to eliminate symptoms and treat PVC-induced cardiomyopathy. Large-scale multicenter outcomes and complication rates have not been reported. METHODS: This retrospective cohort study included 1,185 patients (55% female; mean age 52 ± 15 years; mean ejection fraction 55 ± 10%; mean PVC burden 20 ± 13%) who underwent catheter ablation for idiopathic PVCs at 8 centers between 2004 and 2013. The following factors were evaluated: patient demographics, procedural characteristics, complication rates, and clinical outcomes. RESULTS: Acute procedural success was achieved in 84% of patients. In centers at which patients were followed up routinely with post-ablation Holter monitoring, continued success at clinical follow-up without use of antiarrhythmic drugs was 71%. Including the use of antiarrhythmic medications, the success rate at a mean of 1.9 years of follow-up was 85%. In a multivariate analysis, the significant predictors of acute success were PVC location and number of distinct PVC configurations (p < 0.03). The only significant predictor of continued success at clinical follow-up was a right ventricular outflow tract PVC location (p < 0.01). In 245 patients (21%) with PVC-induced cardiomyopathy, the mean ejection fraction improved from 38% to 50% (p < 0.01) after ablation. Independent predictors for development of PVC-induced cardiomyopathy were male gender, PVC burden, lack of symptoms, and epicardial PVC origin (p < 0.05). The overall complication rate was 5.2% (2.4% major complications and 2.8% minor complications), and complications were most commonly related to vascular access (2.8%). There was no procedure-related mortality. CONCLUSIONS: Catheter ablation of frequent PVCs is a low-risk and often effective treatment strategy to eliminate PVCs and associated symptoms. In patients with PVC-induced cardiomyopathy, cardiac function is frequently restored after successful ablation.
OBJECTIVES: This study reports multicenter outcomes and complications for catheter ablation of premature ventricular complexes (PVCs) and investigates predictors of procedural success, as well as development of PVC-induced cardiomyopathy. BACKGROUND: Catheter ablation of frequent idiopathic PVCs is used to eliminate symptoms and treat PVC-induced cardiomyopathy. Large-scale multicenter outcomes and complication rates have not been reported. METHODS: This retrospective cohort study included 1,185 patients (55% female; mean age 52 ± 15 years; mean ejection fraction 55 ± 10%; mean PVC burden 20 ± 13%) who underwent catheter ablation for idiopathic PVCs at 8 centers between 2004 and 2013. The following factors were evaluated: patient demographics, procedural characteristics, complication rates, and clinical outcomes. RESULTS: Acute procedural success was achieved in 84% of patients. In centers at which patients were followed up routinely with post-ablation Holter monitoring, continued success at clinical follow-up without use of antiarrhythmic drugs was 71%. Including the use of antiarrhythmic medications, the success rate at a mean of 1.9 years of follow-up was 85%. In a multivariate analysis, the significant predictors of acute success were PVC location and number of distinct PVC configurations (p < 0.03). The only significant predictor of continued success at clinical follow-up was a right ventricular outflow tract PVC location (p < 0.01). In 245 patients (21%) with PVC-induced cardiomyopathy, the mean ejection fraction improved from 38% to 50% (p < 0.01) after ablation. Independent predictors for development of PVC-induced cardiomyopathy were male gender, PVC burden, lack of symptoms, and epicardial PVC origin (p < 0.05). The overall complication rate was 5.2% (2.4% major complications and 2.8% minor complications), and complications were most commonly related to vascular access (2.8%). There was no procedure-related mortality. CONCLUSIONS: Catheter ablation of frequent PVCs is a low-risk and often effective treatment strategy to eliminate PVCs and associated symptoms. In patients with PVC-induced cardiomyopathy, cardiac function is frequently restored after successful ablation.
Authors: Edmond M Cronin; Frank M Bogun; Philippe Maury; Petr Peichl; Minglong Chen; Narayanan Namboodiri; Luis Aguinaga; Luiz Roberto Leite; Sana M Al-Khatib; Elad Anter; Antonio Berruezo; David J Callans; Mina K Chung; Phillip Cuculich; Andre d'Avila; Barbara J Deal; Paolo Della Bella; Thomas Deneke; Timm-Michael Dickfeld; Claudio Hadid; Haris M Haqqani; G Neal Kay; Rakesh Latchamsetty; Francis Marchlinski; John M Miller; Akihiko Nogami; Akash R Patel; Rajeev Kumar Pathak; Luis C Saenz Morales; Pasquale Santangeli; John L Sapp; Andrea Sarkozy; Kyoko Soejima; William G Stevenson; Usha B Tedrow; Wendy S Tzou; Niraj Varma; Katja Zeppenfeld Journal: J Interv Card Electrophysiol Date: 2020-10 Impact factor: 1.900
Authors: Edmond M Cronin; Frank M Bogun; Philippe Maury; Petr Peichl; Minglong Chen; Narayanan Namboodiri; Luis Aguinaga; Luiz Roberto Leite; Sana M Al-Khatib; Elad Anter; Antonio Berruezo; David J Callans; Mina K Chung; Phillip Cuculich; Andre d'Avila; Barbara J Deal; Paolo Della Bella; Thomas Deneke; Timm-Michael Dickfeld; Claudio Hadid; Haris M Haqqani; G Neal Kay; Rakesh Latchamsetty; Francis Marchlinski; John M Miller; Akihiko Nogami; Akash R Patel; Rajeev Kumar Pathak; Luis C Sáenz Morales; Pasquale Santangeli; John L Sapp; Andrea Sarkozy; Kyoko Soejima; William G Stevenson; Usha B Tedrow; Wendy S Tzou; Niraj Varma; Katja Zeppenfeld Journal: Europace Date: 2019-08-01 Impact factor: 5.214
Authors: Bulent Gorenek; John D Fisher; Gulmira Kudaiberdieva; Adrian Baranchuk; Haran Burri; Kristen Bova Campbell; Mina K Chung; Andrés Enriquez; Hein Heidbuchel; Valentina Kutyifa; Kousik Krishnan; Christophe Leclercq; Emin Evren Ozcan; Kristen K Patton; Win Shen; James E Tisdale; Mohit K Turagam; Dhanunjaya Lakkireddy Journal: J Interv Card Electrophysiol Date: 2019-12-11 Impact factor: 1.900
Authors: Carlo Lavalle; Marco V Mariani; Agostino Piro; Martina Straito; Paolo Severino; Domenico G Della Rocca; Giovanni B Forleo; Jorge Romero; Luigi Di Biase; Francesco Fedele Journal: J Interv Card Electrophysiol Date: 2019-10-24 Impact factor: 1.900