Key result
Distal-to-proximal delay ≥15 ms accurately predicts successful PVC ablation sites.
Why the study?
Mapping the origin of premature ventricular contractions can be challenging during catheter ablation, prompting evaluation of a new electrophysiological criterion, the distal-to-proximal delay, to localize optimal ablation sites.
Does distal-to-proximal delay accurately localize the optimal site for ablation of premature ventricular contractions in patients with symptomatic PVCs?
Observational
Blinded assessors
Does distal-to-proximal delay accurately localize the optimal site for ablation of premature ventricular contractions in patients with symptomatic PVCs?
A distal-to-proximal delay ≥15 milliseconds is a highly accurate and simple electrophysiological criterion for localizing successful ablation sites for premature ventricular contractions.
May aid PVC ablation site selection; extends mapping criteria but leaves open need for prospective validation.
INTRODUCTION: Ablation of premature ventricular contractions (PVCs) has emerged as a safe and effective treatment in patients experiencing a high PVCs burden. Mapping of PVCs origin may sometimes be challenging. We sought to evaluate the accuracy of a new electrophysiological criterion, the distal-to-proximal (DP) delay, at localizing the optimal site for ablation of ventricular ectopic foci. METHODS AND RESULTS: Consecutive patients with ablation attempts of symptomatic PVCs were included. Prematurity and DP delay-that is, the time duration between the onset of ablation catheter distal bipolar electrogram and the onset of proximal bipolar electrogram-were measured at successful and unsuccessful ablation sites by three blinded experienced electrophysiologists. Mean DP delay at effective ablation sites (N = 30) was significantly higher than at ineffective sites ( N = 55) (23 ± 9 vs 11 ± 8 milliseconds; P < 0.0001). DP delay had good-to-excellent interrater reliability. A DP delay greater than or equal to 15 milliseconds had the highest accuracy at predicting a successful ablation site (sensitivity 0.97, the area under receiver operating characteristic curve 0.87; P < 0.0001). CONCLUSION: DP delay is an additional, simple, and effective electrophysiological parameter to accurately localize PVCs foci.
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Clémenty et al. (2018) conducted an observational in Symptomatic premature ventricular contractions (PVCs). Distal-to-proximal (DP) delay measurement vs. Ineffective ablation sites was evaluated on Mean DP delay at effective versus ineffective ablation sites (AUC 0.87, p=<0.0001). A distal-to-proximal delay ≥15 milliseconds accurately predicted successful ablation sites for premature ventricular contractions (sensitivity 0.97, AUC 0.87; P<0.0001).
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