Key result
Oral caffeine intake significantly increased the 5-minute premature ventricular contraction count during the isoproterenol washout period compared to placebo (73.1 vs 38.9 beats/5 min).
Why the study?
Infrequent appearance and failed induction of PVCs during catheter ablation hinder localization and worsen outcomes, so the effect of preprocedural oral caffeine intake on PVC induction was assessed.
Does preprocedural oral caffeine intake increase the induction of PVCs during catheter ablation in patients with monofocal PVCs?
RCT (n=70)
Computer-generated randomization
No
Does preprocedural oral caffeine intake increase the induction of PVCs during catheter ablation in patients with monofocal PVCs?
Preprocedural oral caffeine intake amplifies the effect of isoproterenol on PVC induction, significantly shortening procedure and ablation times.
May facilitate intraprocedural PVC induction with isoproterenol; leaves open whether it improves ablation outcomes in infrequent-PVC cases.
AIMS: Infrequent appearance and failed induction of premature ventricular contractions (PVCs) at catheter ablation make their localization difficult and are associated with a poor procedural outcome. This study aimed to assess the effect of preprocedural oral caffeine intake on induction of PVCs during catheter ablation. METHODS AND RESULTS: Seventy patients (age: 54 ± 14 years, 37 men) undergoing catheter ablation for monofocal PVCs were randomized to receive oral caffeine (5 mg/kg) or placebo. Before ablation, PVC counts for 5 min were performed at baseline and during isoproterenol infusion and the isoproterenol washout period. PVC count fluctuation was defined as the difference between the highest and lowest 5-min count among the three-time periods. The 5-min PVC counts during baseline and isoproterenol infusion were equivalent between the groups. However, those during the isoproterenol washout period and PVC count fluctuation were significantly higher in the caffeine group than the control group (73.1 ± 73.2 vs. 38.9 ± 28.9 beats/5 min, P = 0.012 and 69.3 ± 61.3 vs. 37.7 ± 30.9 beats/5 min, P = 0.008, respectively). The procedure and ablation times were significantly shorter in the caffeine group than the control group (105.0 ± 23.4 vs. 136.9 ± 43.2 min, P < 0.01 and 219.1 ± 104.7 vs. 283.5 ± 136.0 sec, P < 0.01, respectively). CONCLUSION: Oral caffeine intake amplified the effect of isoproterenol infusion on PVC induction during catheter ablation. The combined use of oral caffeine intake and isoproterenol infusion can be an option to increase intraprocedural PVCs.
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Hasebe et al. (2020) conducted an RCT in Frequent monofocal premature ventricular contractions (PVCs) (n=70). Oral caffeine vs. Placebo (lactose) was evaluated on 5-min PVC count during the isoproterenol washout period (p=0.012). Oral caffeine intake significantly increased the 5-minute premature ventricular contraction count during the isoproterenol washout period compared to placebo (73.1 vs 38.9 beats/5 min).
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