Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland.
Pacing Clin Electrophysiol. 2021 Apr;44(4):703-710. doi: 10.1111/pace.14211. Epub 2021 Mar 15.
Radiofrequency catheter ablation of idiopathic premature ventricular complexes (PVCs) is an effective method for eliminating symptoms and preventing/reversing arrhythmia-induced cardiomyopathy. One reason for procedural failure is low PVC frequency during the procedure. We aimed to investigate the relation between pre-procedural PVC burden and outcome of idiopathic PVC catheter ablation.
Patients who underwent idiopathic PVC ablation between 2013 and 2019 at two tertiary referral centers were retrospectively included. All procedures were performed using irrigated-tip ablation catheters and a 3D electro-anatomical mapping system. Sustained ablation success was defined as a ≥80% reduction of pre-procedural PVC burden determined by 24h-Holter at follow-up.
Overall, 254 patients (median age 54 years [IQR 42-64]; 47% male) were enrolled. The median pre-ablation PVC-burden was 22% (IQR 11-31%), which was reduced to a post-ablation PVC burden of 0.3% (IQR 0-4%) after a median of 90 days. Sustained ablation success was achieved in 182 patients (72%). Pre-procedural PVC burden did not differ between patients with sustained ablation success and recurrence during follow-up (median 21% vs. 22%, p = .76). When assessed in pre-ablation PVC-burden groups of ≤5%, 6-15%, 16-30%, and ≥31%, sustained ablation success was achieved in 67%, 75%, 71%, and 72%, respectively, with no significant difference (p = .89). Sustained ablation outcome for PVC-burden ≤5% versus >5% showed no difference either (67% vs. 72%, p = .52).
Pre-procedural Holter-determined PVC burden does not predict the outcome of idiopathic PVC ablation. Thus, catheter ablation may be a reasonable first choice also for patients with symptomatic yet rare PVCs.
射频导管消融特发性室性早搏（PVCs）是消除症状和预防/逆转心律失常性心肌病的有效方法。手术失败的一个原因是手术过程中 PVC 频率较低。我们旨在研究术前 PVC 负荷与特发性 PVC 导管消融结果之间的关系。
回顾性纳入 2013 年至 2019 年在两个三级转诊中心接受特发性 PVC 消融的患者。所有手术均使用灌流导管和 3D 电解剖标测系统进行。持续性消融成功定义为随访时 24 小时动态心电图监测 PVC 负荷减少≥80%。
共有 254 名患者（中位年龄 54 岁[IQR 42-64]；47%为男性）入选。术前 PVC 负荷中位数为 22%（IQR 11-31%），术后 90 天降至 0.3%（IQR 0-4%）。182 名患者（72%）获得持续性消融成功。在随访期间持续性消融成功和复发的患者之间，术前 PVC 负荷没有差异（中位数 21% vs. 22%，p=0.76）。在术前 PVC 负荷≤5%、6-15%、16-30%和≥31%的患者中，持续性消融成功率分别为 67%、75%、71%和 72%，无显著差异（p=0.89）。PVC 负荷≤5%与>5%的持续性消融结果也无差异（67% vs. 72%，p=0.52）。
术前动态心电图确定的 PVC 负荷不能预测特发性 PVC 消融的结果。因此，导管消融也可能是症状性但 PVC 较少患者的合理首选。
