Radiofrequency catheter ablation of drug refractory symptomatic ventricular ectopy: short- and long-term results

We performed radiofrequency catheter ablation (RFCA) in 12 consecutive patients (17-77 years) with daily, symptomatic, monomorphic ventricular ectopy (VE) (12,096 +/- 3,326 on 24-hour Holter) resistant to antiarrhythmic drugs. Nine patients had no apparent structural heart disease, 1 patient had a mild dilated cardiomyopathy, 1 patient had a treated mitral stenosis, and 1 patient had arrhythmogenic ventricular dysplasia. VE morphology was LBBB with inferior axis in 9 patients, RBBB with inferior axis in 2 patients, RBBB with superior axis in 1 patient. None of the patients had spontaneous or inducible sustained ventricular tachycardia. The VE focus was targeted with RF energy at the earliest endocardial activation site and based on a matching 12-lead ECG pace map. The VE focus was localized in the right outflow tract in 9 patients and on the left ventricle in 3 patients. RFCA was delivered with a standard 4-mm tip electrode. The ablation was initially successful in 11 patients and unsuccessful in 1 patient. All successfully ablated patients were asymptomatic and discharged without antiarrhythmic drugs. During follow-up (25 +/- 8; 17-38 months), two patients had a recurrence of symptoms, which were controlled by a previously ineffective drug. At the end of follow-up, 1,329 +/- 3198 VE were observed on Holter monitoring (P < 0.001 compared with initial values). No short- and long-term complications were observed. RFCA is a safe and effective method for treating drug-resistant symptomatic monomorphic VE in carefully selected patients. A persistent benefit without complications was obtained over a 2-year follow-up.