Key result
Catheter ablation of triggering PVCs in CPVT linked to reducing syncope to ~0.5 events yearly.
Why the study?
Long-term ablation outcomes and the value of catheter ablation in improving exercise-induced ventricular arrhythmias in patients with catecholaminergic polymorphic ventricular tachycardia remain unclear.
Does catheter ablation of triggering premature ventricular contractions reduce syncope recurrence and improve exercise-induced ventricular arrhythmias in patients with catecholaminergic polymorphic ventricular tachycardia refractory to beta-blockers?
Cohort (n=14)
No
Does catheter ablation of triggering premature ventricular contractions reduce syncope recurrence and improve exercise-induced ventricular arrhythmias in patients with catecholaminergic polymorphic ventricular tachycardia refractory to beta-blockers?
Absolute Event Rate: 0.5% vs 4.3%
p-value: p=<0.001
Catheter ablation of triggering PVCs in CPVT patients refractory to maximum beta-blockers is a feasible adjunctive therapy that significantly reduces syncope burden and exercise-induced ventricular arrhythmias.
Background Catheter ablation of premature ventricular contractions (PVCs) that trigger polymorphic ventricular tachycardia (PVT) or ventricular fibrillation has been reported as a novel therapy to reduce the syncope events in patients with catecholaminergic PVT, whereas the long‐term ablation outcome and its value in improving exercise‐induced ventricular arrhythmias remain unclear. Methods and Results Fourteen consecutive selected patients with catecholaminergic PVT (mean±SD age, 16±6 years; 43% male patients) treated with maximum β‐blockers with no possibility of adding flecainide were prospectively enrolled for catheter ablation. The primary end point was syncope recurrence, and the secondary end point was the reduction of the ventricular arrhythmia score during exercise testing. Twenty‐six PVT/ventricular fibrillation–triggering PVCs were identified for ablation. The trigger beats arose from the left ventricle in 50% of the cases and from both ventricles in 36% of the cases. Purkinje potentials were observed at 27% of the targets. After a mean follow‐up of 49 months after ablation, 8 (57%) patients were free from syncope recurrence. Ablation of trigger beat significantly reduced the syncope frequency (mean±SD, 4.3±1.6 to 0.5±0.8 events per year; P <0.001) and improved the ventricular arrhythmia scores at the 3‐month (5 [range, 3–6] to 1.5 [range, 0–5]; P =0.002) and 12‐month (5 [range, 3–6] to 2 [range, 0–5]; P =0.014) follow‐ups. The induction of nontriggering PVCs postablation was closely associated with syncope recurrence (hazard ratio, 6.8 [95% CI, 1.3–35.5]; P =0.026). Conclusions Catheter ablation of PVT/ventricular fibrillation–triggering PVCs in patients with catecholaminergic PVT who cannot receive flecainide treatment seems to be a safe and feasible adjunctive treatment that may reduce the syncope burden and improve exercise‐related ventricular arrhythmias. Induction of nontriggering PVCs after ablation is associated with a higher risk of syncope recurrence.
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Shen et al. (2023) conducted a cohort in Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT) (n=14). Catheter ablation of PVT/VF-triggering PVCs vs. Pre-ablation (self-controlled matched periods) was evaluated on Syncope frequency (events per year) (p=<0.001). Catheter ablation of PVT/VF-triggering PVCs in patients with catecholaminergic polymorphic ventricular tachycardia significantly reduced syncope frequency from 4.3 to 0.5 events per year.
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