Milaras Nikias, Ktenopoulos Nikolaos, Karakasis Paschalis, Karanikola Aikaterini-Eleftheria, Michopoulos Vasileios, Pamporis Konstantinos, Dourvas Panagiotis, Apostolos Anastasios, Sotiriou Zoi, Archontakis Stefanos, Kordalis Athanasios, Gatzoulis Konstantinos, Sideris Skevos
State Department of Cardiology, "Hippokration" General Hospital of Athens, 11527 Athens, Greece.
School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece.
Biomedicines. 2025 Jun 17;13(6):1488. doi: 10.3390/biomedicines13061488.
Frequent premature ventricular complexes (PVCs) are associated with adverse outcomes in patients with structural heart disease (SHD), including increased risk of mortality and impaired left ventricular ejection fraction (LVEF). While radiofrequency ablation (RFA) of idiopathic PVCs is well established, its role in patients with SHD remains less clear. To review the evidence on the efficacy of RFA for PVC suppression in patients with SHD, specifically evaluating its impact on LVEF and clinical outcomes. A review of the literature was conducted using PubMed and the Cochrane Library, focusing on studies published after 2010 that included adult patients with SHD and a PVC burden >4% on 24 h Holter monitoring. Studies including patients with presumed PVC-induced cardiomyopathy without underlying SHD were excluded. Key outcomes were LVEF recovery, functional status, and procedural success rates. In ischemic cardiomyopathy, RFA reduced PVC burden significantly and resulted in modest but significant LVEF improvement. In non-ischemic cardiomyopathy, successful ablation improved LVEF by 8-12% on average and enhanced NYHA class. Across mixed cohorts, patients with sustained PVC suppression showed significant improvements in LVEF, functional status, which, in many cases, removed the indication for implantable cardioverter-defibrillators. Notably, procedural success rates ranged from 60 to 94%, and the high baseline PVC burden (>13-20%) consistently predicted LVEF recovery regardless of SHD etiology. RFA of frequent PVCs in patients with SHD leads to meaningful improvements in systolic function and symptoms, particularly in those with high PVC burden. These benefits are seen across ischemic and non-ischemic substrates, although procedural complexity and recurrence rates may be higher. PVC burden, rather than SHD presence alone, should guide patient selection for ablation.
频发室性早搏（PVC）与结构性心脏病（SHD）患者的不良预后相关，包括死亡率增加和左心室射血分数（LVEF）受损。虽然特发性PVC的射频消融（RFA）已得到充分证实，但其在SHD患者中的作用仍不太明确。为了回顾关于RFA抑制SHD患者PVC疗效的证据，特别评估其对LVEF和临床结局的影响。使用PubMed和Cochrane图书馆对文献进行了综述，重点关注2010年后发表的研究，这些研究纳入了24小时动态心电图监测显示PVC负荷>4%的成年SHD患者。排除包括疑似PVC诱发的心肌病但无潜在SHD的患者的研究。主要结局为LVEF恢复、功能状态和手术成功率。在缺血性心肌病中，RFA显著降低了PVC负荷，并导致LVEF有适度但显著的改善。在非缺血性心肌病中，成功消融平均使LVEF提高了8 - 12%，并改善了纽约心脏协会（NYHA）心功能分级。在混合队列中，PVC持续抑制的患者LVEF、功能状态有显著改善，在许多情况下，消除了植入式心脏复律除颤器的指征。值得注意的是，手术成功率在60%至94%之间，无论SHD病因如何，高基线PVC负荷（>13 - 20%）始终预示着LVEF恢复。SHD患者频发PVC的RFA可使收缩功能和症状有显著改善，尤其是在PVC负荷高的患者中。尽管手术复杂性和复发率可能更高，但在缺血性和非缺血性基质中均可见到这些益处。应根据PVC负荷而非仅根据SHD的存在来指导患者的消融治疗选择。
