Predictors of outcome after catheter ablation of premature ventricular complexes

The purpose of this study was to assess how well acute procedural outcomes predict the clinical outcome of catheter ablation of premature ventricular complexes (PVCs).

A consecutive series of 50 patients (28 women, age: 51 ± 13 years) with frequent PVCs was referred for PVC ablation. Acute failure was defined as inability to eliminate the predominant PVC or recurrence of the predominant PVC within 12 hours. The PVC burden was reassessed 3 months after the ablation procedure. A successful procedure was defined as reduction of the PVC burden at 3 months by ≥80% of the initial burden.

The procedure was acutely effective in 37 patients (74%) and at 3 months in 40 patients (80%). The presence or absence of the predominant PVC in the 12 hours postablation had the highest accuracy for outcome at 3 months (accuracy: 90%). From among the 13/50 patients (26%) with evidence of acute failure, 4 had a PVC reduction of ≥80% at 3 months and 10 had a PVC reduction of >50% resulting in symptomatic improvement at 3 months.

The presence or absence of the predominant PVC within 12 hours postablation best correlated with the 3-month-efficacy data. Recurrence of the predominant PVC shortly after ablation did not indicate a procedural failure and the necessity for a repeat procedure. The majority of these patients had a significant, clinically meaningful reduction in their PVC burden. Acute predictors for procedural outcome at 3 months have a high positive but rather low negative predictive value.