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

During PVC ablation, operators need real-time feedback to optimize outcomes. We hypothesized that PVC Termination Time (PTT)-the interval from radiofrequency onset to PVC disappearance-would outperform local activation time (LAT) in predicting acute success.

To evaluate the predictive value of PTT compared with LAT in PVC ablation.

We analyzed 310 applications in 54 patients undergoing PVC ablation. PTT and LAT were measured for each application. Acute success was defined as elimination of PVCs without recurrence within 30 min. ROC and logistic regression analyses were performed, with location-specific analyses and long-term follow-up.

Acute success was achieved in 50/54 patients (92.6%). PTT was significantly shorter in successful versus failed applications (median 12s [IQR 8-18] vs. 62s [IQR 45-75], p < 0.0001). LAT was earlier in successful applications (-36ms vs. - 26.5ms, p < 0.01). PTT showed superior predictive accuracy (AUC = 0.93) versus LAT (AUC = 0.72). A PTT cutoff of 25s yielded 88% sensitivity and 83% specificity. Location-specific analysis showed variability, especially in LV summit cases. In multivariable analysis, both shorter PTT (p < 0.001) and earlier LAT (p = 0.005) predicted success. Long-term follow-up (18 ± 6 months, n = 48) demonstrated 85.4% freedom from recurrence; recurrent cases had longer PTT during index ablation (28.5s vs. 11.5s, p = 0.008).

PTT is a practical, real-time predictor of acute PVC ablation success, outperforming LAT. A 25s cutoff provides objective procedural guidance, though anatomical variations should be considered.