Catheter ablation for idiopathic premature ventricular complexes: a single-centre experience

The most common site of origin of idiopathic premature ventricular complexes (PVCs) is the right ventricular outflow tract (RVOT). This study reports a single-centre UK National Health Service (NHS)-based experience of catheter ablation (CA) for idiopathic PVCs. We conducted a retrospective review of the electronic patient record, searching for all patients undergoing idiopathic PVC ablation at Guy's and St Thomas' NHS Foundation Trust (GSTT) between January 2016 and June 2023. There were 147 procedures performed in 118 patients: 21 patients underwent repeat ablations. There were 75% originating in the RVOT and 11% from the left ventricular outflow tract (LVOT). Acute suppression of PVCs was achieved in 121 procedures (82%). Following acutely successful ablations, PVC burden reduction was greater in RVOT (85% decrease) than LVOT PVCs (44% decrease) at follow-up (p=0.03). There were 12 patients with PVC-induced cardiomyopathy identified. Following successful ablation (n=9), left ventricular ejection fraction (LVEF) increased from 38% to 49%. Symptomatic improvement after ablation was reported by 80%, with 64% having complete symptomatic resolution. Patients experiencing complete symptom resolution had a 92% decrease in PVC burden, whereas patients with residual symptoms had a 76.2% decrease (p=0.03). Procedural complications occurred in 10 procedures (6.8%): five were classified as major, including four pericardial effusions requiring pericardiocentesis, and one cardioversion for pulseless ventricular tachycardia. In conclusion, CA is an effective and safe strategy for PVC suppression in idiopathic PVCs, and may result in a significant symptomatic improvement even without complete PVC suppression. Among those with PVC-induced cardiomyopathy, CA results in improved LVEF.