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Neurohormonal, structural, and functional recovery pattern after premature ventricular complex ablation is
Diego Penela1, Carine Van Huls Van Taxis, Carine Van Huls Vans Taxis
1Department of Cardiology, Thorax Institute, Hospital Clínic and Institut d'Investigació Agustí Pi i Sunyer, Barcelona, Spain.
Insights
Ablation of frequent premature ventricular complexes (PVC) significantly improves left ventricular (LV) function and heart failure symptoms in patients with LV dysfunction. This benefit is observed regardless of structural heart disease (SHD) and is linked to PVC burden.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Management
Background:
- Premature ventricular complexes (PVC) can lead to left ventricular (LV) dysfunction.
- Current guidelines often restrict PVC ablation to cases of suspected PVC-induced cardiomyopathy.
Purpose of the Study:
- To evaluate the benefits of PVC ablation in patients with LV dysfunction, irrespective of underlying structural heart disease (SHD).
- To assess the impact of ablation on LV ejection fraction (LVEF), heart failure symptoms, and need for device implantation.
Main Methods:
- Prospective study including 80 patients with frequent PVC and LV dysfunction undergoing ablation across 4 centers.
- Data collected included SHD diagnosis, PVC burden, LVEF, BNP levels, and NYHA functional class.
Main Results:
- Successful sustained ablation (SSA) achieved in 66% of patients, leading to significant LVEF improvement from 33.7% to 45.8% at 12 months.
- BNP levels decreased, and NYHA class I patients increased significantly post-ablation.
- A baseline PVC burden >13% predicted LVEF improvement; device implantation indications resolved in some patients post-ablation.
Conclusions:
- Successful PVC ablation in patients with depressed LVEF induces significant clinical and functional improvement.
- Improvement is independent of SHD presence and correlates with baseline PVC burden and ablation success.
- PVC ablation offers a viable treatment strategy for improving heart failure parameters in this patient population.
Objectives:
This study aimed to assess the benefit after ablation of premature ventricular complexes (PVC) in patients with frequent PVC and left ventricular (LV) dysfunction, regardless of previous structural heart disease (SHD) diagnosis, PVC morphology, or estimated site of origin.
Background:
Ablation of PVC in patients with LV dysfunction is usually restricted to patients with suspected PVC-induced cardiomyopathy.
Methods:
Consecutive patients with frequent PVC and LV dysfunction accepted for ablation at 4 centers were prospectively included. Of the 80 patients included, 27 (34%) had a diagnosis of SHD.
Results:
Successful sustained ablation (SSA) was achieved in 53 (66%) patients, and LVEF improved in these patients from 33.7 ± 8% to 43.8 ± 9.4% and 45.8 ± 10.9% at 6 and 12 months, respectively (p < 0.05), without differences related to previous diagnosis of SHD (p = 0.69). BNP decreased from 109 [64 to 242] pg/ml to 60 [25 to 170] pg/ml, 50 [14 to 130] pg/ml, and 60 [19 to 81] pg/ml at 1, 6, and 12 months (p < 0.05). Patients in NYHA class I increased from 12 (23%) to 42 (79%) at 12 months (p < 0.05). A 13% baseline PVC burden had 100% sensitivity and 85% specificity to predict an absolute increase ≥ 5% in LVEF after SSA. Although 20 patients with >13% PVC and SSA had class I indication for cardioverter defibrillator implantation, these indications were absent at 6 months post-ablation.
Conclusions:
Independently of the presence of SHD, the SSA of frequent PVC in patients with depressed LVEF induced a progressive clinical and functional improvement. Improvement in heart failure parameters was related to baseline PVC burden and persistence of ablation success.
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