Long-Term Outcomes and Post-Ablation Medication De-Escalation After Catheter Ablation for Premature Ventricular Complexes: A Nationwide Cohort Study

Purpose: Frequent premature ventricular complexes are increasingly recognized as a contributor to ventricular dysfunction and progression to heart failure. Current clinical guidelines endorse radiofrequency catheter ablation as an effective treatment for symptomatic or drug-refractory premature ventricular complexes. However, nationwide long-term real-world outcomes, particularly those related to post-ablation medication de-escalation, remain insufficiently characterized. Patients and Methods: Using Taiwan's National Health Insurance Research Database, we conducted a nationwide retrospective cohort study of adults who underwent first-time radiofrequency catheter ablation for premature ventricular complexes between 2002 and 2018, with follow-up extending to December 31, 2021, allowing for up to three years of observation. Clinical outcomes included all-cause mortality and heart failure rehospitalization. Antiarrhythmic drug utilization was assessed through both prescription prevalence and defined daily dose, evaluated at baseline, 90 days, and 1 year post-ablation. Subgroup analyses were stratified by baseline heart failure status. Results: A total of 4195 patients (mean age 53±15 years; 49% women) were included, of whom 7% had heart failure. Baseline heart failure independently predicted mortality (hazard ratio 3.99, 95% confidence interval 2.71-5.88) and heart failure rehospitalization (hazard ratio 7.29, 95% confidence interval 5.49-9.66). Radiofrequency catheter ablation was associated with substantial reductions in antiarrhythmic drug use, declining from 58% before the procedure to 31% at 1 year. Medication analysis confirmed dose de-escalation, particularly for mexiletine, propafenone, and amiodarone. However, patients with heart failure exhibited smaller reductions in beta-blockers and Class III agents. Conclusion: This nationwide cohort offers real-world insight into radiofrequency catheter ablation outcomes for frequent premature ventricular complexes, highlighting divergent prognoses between patients with and without heart failure. Radiofrequency catheter ablation was associated with meaningful reductions in antiarrhythmic medication use, underscoring its potential therapeutic and economic benefits. These findings support radiofrequency catheter ablation as a component of long-term management strategies, while future prospective studies are needed to refine candidate selection and timing of intervention.