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Circadian variability patterns predict and guide premature ventricular contraction ablation procedural inducibility
David Hamon1, Guillaume Abehsira2, Kai Gu3
1UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, California; AP-HP, University Hospital Henri Mondor, Department of Cardiology, Creteil, France.
Heart Rhythm
|August 3, 2017
Summary
Analyzing premature ventricular complex (PVC) circadian variation helps predict drug response for radiofrequency ablation (RFA). Certain PVC patterns indicate poor RFA outcomes, guiding treatment decisions.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Infrequent premature ventricular complexes (PVCs) can negatively impact radiofrequency catheter ablation (RFA) success.
- Pharmacologic induction of PVCs for RFA is often unpredictable.
Purpose of the Study:
- To investigate if PVC circadian variation can predict patient response to pharmacologic agents.
- To assess the utility of Holter monitoring in guiding RFA procedures.
Main Methods:
- Patients undergoing RFA with frequent monomorphic PVCs were categorized based on the correlation between hourly PVC counts and heart rate (HR) during 24-hour Holter monitoring.
- Groups included fast-HR-dependent PVC (F-HR-PVC), slow-HR-dependent PVC (S-HR-PVC), and independent-HR-PVC (I-HR-PVC).
Main Results:
- Over half of patients (50.5%) exhibited F-HR-PVC, with 39.6% I-HR-PVC and 9.9% S-HR-PVC.
- Only F-HR-PVC patients responded to isoproterenol; S-HR-PVC patients responded to isoproterenol washout or phenylephrine.
- Patients with infrequent I-HR-PVC had significantly lower RFA success rates (15.4%) compared to those who responded to drugs (77.8%) or had frequent baseline PVCs (82.9%).
Conclusions:
- Circadian variability analysis of PVCs offers valuable insights for guiding pharmacologic induction during RFA and predicting procedural outcomes.
- Patients with infrequent I-HR-PVC demonstrate the poorest outcomes following RF ablation.
Keywords:
Autonomic nervous systemCircadian profileIsoproterenolPremature ventricular complexesRadiofrequency ablationMore Related Videos
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