Outcome of repeat ablation for premature ventricular contractions in patients with prior ablation failure: Impact of advanced techniques

BACKGROUND: The utility of repeat ablation for premature ventricular contractions (PVCs) after prior ablation failure is not clear. OBJECTIVE: The purpose of this study was to assess the outcomes of repeat ablation and the use of different techniques in patients who failed prior PVC ablation. METHODS: We reviewed 239 consecutive patients who underwent PVC ablation. When standard endocardial ablation with normal or half-normal saline failed, we considered an advanced ablation technique. Acute success was defined as abolition of the target PVC. Clinical and procedural findings, PVC origins, and acute and follow-up outcomes were compared in those with and without a prior failed ablation procedure. RESULTS: Of 239 patients, 75 (31%) had failed a prior ablation procedure, and they more often had left ventricular outflow tract PVCs. Despite failing prior ablation, repeat standard ablation was acutely successful in 59% of patients, and 75% of these patients had long-term success. Acute standard ablation success rate was lower and long-term recurrence rate was higher than in patients without prior ablation (59% vs 95%, P <.001; and 29% vs 17%, P <.05, respectively). Of the 31 repeat standard procedures that again failed, advanced techniques were performed in 23 (16 needle, 5 epicardial, 2 simultaneous ablation) and were acutely successful in 16 (70%) with long-term success in 14 (45%). Overall long-term success for patients with prior failed standard ablation was 71%. CONCLUSION: Although success is lower for patients with prior failed ablation, repeat ablation seems reasonable for many, and the use of advanced techniques increased success to 71% in this group.