PVC termination time: a novel real-time predictor of ablation success

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Optimizing outcomes in premature ventricular contraction (PVC) ablation requires real-time operator feedback.
• PVC Termination Time (PTT), the interval from radiofrequency onset to PVC disappearance, was hypothesized to predict acute success better than local activation time (LAT).

Purpose of the Study:

• To evaluate the predictive value of PTT compared to LAT in PVC ablation procedures.
• To determine if PTT is a superior real-time metric for assessing acute success in PVC ablation.

Main Methods:

• Analysis of 310 ablation applications in 54 patients, measuring both PTT and LAT.
• Receiver Operating Characteristic (ROC) and logistic regression analyses were performed to assess predictive accuracy.
• Location-specific analyses and long-term follow-up were conducted to evaluate recurrence rates.

Main Results:

• Acute ablation success was achieved in 92.6% of patients.
• Shorter PTT (median 12s vs. 62s) and earlier LAT (-36ms vs. -26.5ms) were associated with successful ablations.
• PTT demonstrated superior predictive accuracy (AUC=0.93) compared to LAT (AUC=0.72), with a 25s cutoff showing 88% sensitivity and 83% specificity.

Conclusions:

• PTT serves as a practical, real-time predictor of acute PVC ablation success, outperforming LAT.
• A PTT cutoff of 25s provides objective guidance for procedural success, with consideration for anatomical variations.
• Long-term follow-up confirmed the efficacy of PTT in predicting freedom from recurrence.