Key result
Radiofrequency catheter ablation of frequent PVCs improved mean LVEF from 37.1% to 48.6% at 6 months, with significant recovery in 75% of successful cases regardless of structural heart disease.
Why the study?
Does radiofrequency catheter ablation of frequent premature ventricular complexes improve left ventricular ejection fraction in patients with LV dysfunction regardless of the presence of concomitant structural heart disease?
Cohort (n=77)
All echocardiographic examinations were done by the same physician who was blinded to the study results
No
Does radiofrequency catheter ablation of frequent premature ventricular complexes improve left ventricular ejection fraction in patients with LV dysfunction regardless of the presence of concomitant structural heart disease?
Radiofrequency ablation of frequent PVCs (>10% burden) significantly improves LV systolic function in 75% of successfully ablated patients regardless of concomitant structural heart disease, with pre-ablation PVC burden >18% and post-ablation burden <8% strongly predicting LVEF recovery.
Answers are grounded in this paper and cite their sources.
Supports ablation of frequent PVCs in LV dysfunction; hypothesis-generating pending randomized confirmation across structural heart disease.
BACKGROUND: We examined the effect of radiofrequency (RF) catheter ablation of premature ventricular complexes (PVCs) on left ventricle (LV) function recovery in patients with LV dysfunction, regardless the presence of structural heart disease (SHD). METHODS: Seventy seven patients with impaired LV ejection fraction (EF) (37.1±9.4), suspected to have PVCs cardiomyopathy (PVC-CM) (>10% PVCs burden), referred for RF ablation were enrolled, and divided into 2 groups according to the presence of SHD. SHD was ruled out by echocardiography, coronary angiography or MRI. CARTO 3 mapping system was used employing activation mapping in the majority of cases. Initial success was defined as complete elimination or residual PVCs≤10 beats/30min. Long term success was defined as reduction in PVCs burden >80% on follow-up holter. Echocardiography was done after 6 months. Improvement of EF >5% was considered significant. RESULTS: Forty two (55.8%) cases had SHD. PVCs burden was 28.4±9.8%. EF improved to 48.6±10.3. Initial success, overall success, post procedural PVCs burden and EF were comparable in both groups. EF improved in 47(75%) of successful cases with no significant differences between both groups. Post-MI Patients were the least category to improve. PVCs burden before and after ablation were the independent predictors of LVEF recovery by multivariate analysis. Cutoff values of >18%, <8% had 100% sensitivity and 85%, 87% specificity, respectively. CONCLUSIONS: PVCs elimination by RF ablation results in significant improvement even restoration of LV function regardless of PVC origin, or the presence of concomitant SHD. PVCs burden before and after ablation are the main predictors of LVEF recovery.
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Abdelhamid et al. (2017) conducted a cohort in Premature ventricular complexes induced cardiomyopathy (LV dysfunction with LVEF <50% and >10% PVC burden) (n=77). Radiofrequency catheter ablation of PVCs (comparing concomitant structural heart disease vs idiopathic) vs. Idiopathic PVC cardiomyopathy (Group A, absence of structural heart disease, n=35) vs Structural Heart Disease (Group B, n=42) was evaluated on Significant LVEF recovery (improvement of LVEF ≥5% at 6 months follow-up) (p=>0.05). Radiofrequency catheter ablation of frequent PVCs improved mean LVEF from 37.1% to 48.6% at 6 months, with significant recovery in 75% of successful cases regardless of structural heart disease.
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