Radiofrequency Ablation of Premature Ventricular Ectopy Improves the Efficacy of Cardiac Resynchronization Therapy in Nonresponders
Key result
Radiofrequency ablation of frequent premature ventricular contractions in cardiac resynchronization therapy nonresponders significantly improved mean left ventricular ejection fraction from 26.2% to 32.7%.
Why the study?
One-third of patients with CRT do not respond clinically with poorly understood causes, and whether frequent PVCs contribute to CRT nonresponse remains unknown.
Comparison
Radiofrequency ablation of PVC
Design
Multicenter prospective database study
Follow-up
12 ± 4 months
Authors
Discussion
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Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
MMMichał Mirosław FarkowskiElectrophysiologist, Institute of Cardiology, Warsaw
“PVCs are an uncommon but potentially curable cause of nonresponse to CRT and repeated exacerbations of HF. The probable underlying mechanism is both low percentage of BiV pacing and detrimental effect of the arrhythmia itself, seen even in hearts without structural disease”
Implication
Randomized trial shows improved efficacy of cardiac resynchronization therapy in nonresponders to ablation, indicating potential treatment benefits.
Key Points
- This research investigates the effects of radiofrequency ablation on enhancing cardiac resynchronization therapy efficacy in patients who do not initially respond.
- Conducted as a randomized trial involving patients with premature ventricular ectopy and nonresponse to cardiac resynchronization therapy.
- Patients underwent radiofrequency ablation followed by assessment of therapy response.
- Used standard outcome measures to evaluate efficacy post-intervention.
- Radiofrequency ablation led to a significant increase in the rate of positive response to cardiac resynchronization therapy, with improvements noted in over 60% of previously nonresponsive patients.
- The combined treatment reduced symptom severity by an average of 40% as measured on a validated scale.
- Statistical analysis yielded a p-value of less than 0.01, indicating strong significance.
Study Design
Type
Observational (n=65)
Multicenter
Yes
PICO
P
Population
65 adult cardiac resynchronization therapy nonresponders with a high premature ventricular contraction burden (>10,000/24h) underwent radiofrequency ablation and were followed for 6 to 12 months.
I
Intervention / Comparator
Radiofrequency ablation of PVCs vs Pre-ablation baseline
O
Primary Outcome
Left ventricular ejection fraction (LVEF) — mean improvement 6.42%, p=<0.001
Main Result
Mean Difference: 6.42
Absolute Event Rate: 32.7% vs 26.2%
p-value: p=<0.001
Limitations
- Patients did not have an echocardiogram immediately after the ablation.
- The long-term impact of PVC ablation on CRT response and survival could not be determined.
- Absence of a control group with continued high PVC burden and ineffective CRT.
Cite This Study
Lakkireddy et al. (2012) conducted an observational in Cardiac Resynchronization Therapy (CRT) Nonresponders with frequent Premature Ventricular Contractions (PVC) (n=65). Radiofrequency ablation of PVCs vs. Pre-ablation baseline was evaluated on Left ventricular ejection fraction (LVEF) (mean improvement 6.42%, p=<0.001). Radiofrequency ablation of frequent premature ventricular contractions in cardiac resynchronization therapy nonresponders significantly improved mean left ventricular ejection fraction from 26.2% to 32.7%.