A nonlocalized earliest-strain pattern on echocardiography was associated with a lower rate of successful simple ablation compared to a localized pattern (20.0% vs 83.3%; P=0.035).
Observational (n=16)
Does 2-dimensional speckle-tracking echocardiography predict ablation complexity in patients with left ventricular outflow tract premature ventricular contractions?
Preprocedural 2-dimensional speckle-tracking echocardiography can identify nonlocalized strain patterns that predict the need for more complex ablation strategies in patients with left ventricular outflow tract PVCs.
Absolute Event Rate: 20% vs 83.3%
p-value: p=0.035
BACKGROUND: The origins of left ventricular outflow tract premature ventricular contractions (PVCs) differ in depth and may involve preferential pathways, potentially requiring complex ablation. However, a noninvasive method to preprocedurally estimate ablation complexity has not been established. METHODS: Sixteen patients with idiopathic left ventricular outflow tract PVCs (V2 transition ratio ≥0.6) underwent 2-dimensional speckle-tracking echocardiography during monomorphic PVCs. Endocardial peak systolic strain timing in 18 left ventricular segments was displayed on a bull’s-eye map using 8 color-coded intervals (0–800 ms). Patients were classified as localized (n=6) when the earliest interval appeared in 1 segment and nonlocalized (n=10) when it involved ≥2 segments. Ablation outcomes were compared according to whether a simple ablation approach (PVC elimination within 30 s at a single site) was achieved. RESULTS: Baseline electrocardiographic characteristics were comparable between the groups. Ablation-related parameters, including contact force, power output, and impedance drop at the initial ablation site, were also similar. However, the nonlocalized group required statistically significantly greater total radiofrequency energy to eliminate the targeted PVCs (median, 22 206 versus 10 409 J; P =0.031) and demonstrated a statistically significantly lower rate of successful simple ablation approach compared with the localized group (20.0% versus 83.3%; P =0.035). Nonlocalized patterns may reflect conduction from deeper origins with preferential pathways, thereby requiring more complex ablation strategies. CONCLUSIONS: A localized earliest-strain pattern was associated with successful PVC elimination using a simple ablation approach, whereas a nonlocalized pattern indicated the need for more complex ablation. This simple, noninvasive metric may aid preprocedural planning for left ventricular outflow tract PVC ablation.
Yamada et al. (Wed,) conducted a observational in Idiopathic left ventricular outflow tract premature ventricular contractions (n=16). Nonlocalized earliest-strain pattern vs. Localized earliest-strain pattern was evaluated on Successful simple ablation approach (PVC elimination within 30 s at a single site) (p=0.035). A nonlocalized earliest-strain pattern on echocardiography was associated with a lower rate of successful simple ablation compared to a localized pattern (20.0% vs 83.3%; P=0.035).