Best ablation strategy in patients with premature ventricular contractions with multiple morphology: a single-centre
Sanghamitra Mohanty1, John D Burkhardt1, Luigi Di Biase1,2
1Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, TCAI: 1015 east 32nd street, suite 408, Austin, TX-78705, USA.
Insights
Ablating all premature ventricular complex (PVC) morphologies, not just the predominant one, significantly reduces PVC burden and improves left ventricular ejection fraction (LVEF) in patients with reduced LVEF. This comprehensive approach offers long-term clinical benefits.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Reduced left ventricular ejection fraction (LVEF) is often associated with high burden of premature ventricular complexes (PVCs).
- The optimal ablation strategy for patients with multiple PVC morphologies and reduced LVEF remains under investigation.
Purpose of the Study:
- To compare the clinical benefits of ablating all PVC morphologies versus only the predominant morphology in patients with reduced LVEF.
- To assess the long-term impact of these ablation strategies on PVC burden and LVEF.
Main Methods:
- An observational study included 171 patients with reduced LVEF and high PVC burden (>10%/day) undergoing their first ablation.
- Initial procedures focused on dominant PVCs in most patients, while a subset underwent ablation of all morphologies.
- Redo procedures targeted all PVC morphologies, with long-term follow-up assessing PVC burden and LVEF.
Main Results:
- Ablation of all PVC morphologies was associated with significantly lower PVC burden at long-term follow-up compared to dominant morphology ablation.
- Patients undergoing ablation of all morphologies showed improved LVEF post-procedure.
- Successful ablation of all PVC morphologies led to a sustained reduction in PVC burden and LVEF improvement.
Conclusions:
- Targeted ablation of all PVC morphologies is clinically superior to ablating only the dominant morphology in patients with reduced LVEF.
- This comprehensive ablation strategy offers significant long-term benefits, including reduced PVC burden and improved cardiac function.
Aims:
This study aimed to examine the clinical benefits of targeted ablation of all Premature ventricular complex (PVC) morphologies vs. predominant PVC only.
Methods And Results:
A total of 171 consecutive patients with reduced left ventricular ejection fraction (LVEF) and ≥2 PVC morphology with high burden (>10%/day) undergoing their first ablation procedure were included in the analysis. At the initial procedure, prevalent PVC alone was ablated in the majority. However, at the redo, all PVC morphologies were targeted for ablation. : At the first procedure, 152 (89%) patients received ablation of the dominant PVC only. In the remaining 19 (11%) patients, all PVC morphologies were ablated. At two years, high PVC burden was detected in 89 (52%) patients. Repeat procedure was performed in 78 of 89, where all PVC morphologies were ablated. At 5 years after the repeat procedure, 71 (91%) had PVC burden of <5% [3.8 ± 1.1% vs. 15.4 ± 4.3% in successful vs. failed subjects (P < 0.001)]. In patients with low PVC burden after the initial procedure, LVEF improved from 37.5% to 41.6% [mean difference (MD): 3.39 ± 2.9%, P < 0.001], whereas a reduction in LVEF from 39.8% to 34.5% (MD: 6.45 ± 4.7%, P < 0.001) was recorded in patients with high PVC burden. One year after the repeat procedure, LVEF improved from 36.2% to 41.7% (MD: 5.5 ± 4.3%, P < 0.001) in patients with successful ablation.
Conclusion:
In this observational series, ablation of all PVC morphologies was associated with significantly lower PVC burden and improvement of LVEF at long-term follow-up, compared with ablation of the dominant morphology only.
More Related Videos
10:17Real-Time Cardiac Mapping with a Noninvasive Imageless Electrocardiographic Imaging System
Published on: April 11, 2025
12:45Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
Published on: December 11, 2017
Related Concept Videos
01:25ECG Interpretation of Arrhythmias II: Atrial, Junctional and Ventricular Arrhythmias
01:29Disturbances in Heart Rhythm
Arrhythmias are categorized by their speed, rhythm, and origin. A slow heart...
01:25Dysrhythmias VI: Management of Dysrhythmias
01:18Dysrhythmias IV: Characteristics of Bradyarrhythmias
01:29Dysrhythmias III: Characteristics of Dysrhythmias
01:29Cardiomyopathy III: Hypertrophic Cardiomyopathy