Effect of ablation of frequent premature ventricular complexes on left ventricular function in patients with nonischemic cardiomyopathy
Introduction
Frequent idiopathic premature ventricular complexes (PVCs) are not associated with an increased risk of sudden death1 but can cause a cardiomyopathy that is reversible by radiofrequency ablation of the PVCs.2, 3 An improvement in left ventricular function after ablation of frequent PVCs also can occur in patients with prior myocardial infarction.4 Whether patients with nonischemic cardiomyopathy and frequent PVCs also would benefit from an ablation procedure is unclear. The purpose of this study was to assess whether patients with frequent PVCs and nonischemic cardiomyopathy can benefit from an ablation procedure.
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Characteristics of subjects
The study protocol was approved by the institutional review committee of the University of Michigan. The subjects of this study were 30 consecutive patients with nonischemic cardiomyopathy referred for radiofrequency catheter ablation of frequent PVCs (Table 1). Significant coronary artery disease was ruled out by cardiac catheterization, and there was no remote history of prior myocardial infarction. The patients were diagnosed as having nonischemic cardiomyopathy based on the presence of left
Ablation results and ejection fraction (Tables 2 and 3, and Figures 3 and 4)
Ablation was performed in the left ventricle in 20 patients and in the right ventricle in 12 patients. In 5 patients, ablation was also performed from an aortic cusp, and in 3 patients, ablation was also performed within the coronary venous system. A successful ablation procedure resulted in improvement of mean ejection fraction from 33.9% ± 14% to 45.7% ± 17% (P < .0001). In 10 of 18 patients in whom the procedure was successful, ejection fraction normalized and improved from 39% ± 7% to 55% ±
Main findings
In this study, we demonstrated that successful catheter ablation in patients with nonischemic cardiomyopathy and frequent PVCs can improve but will not always normalize left ventricular ejection fraction and functional heart failure class. Furthermore, scar tissue was present at the site of origin in most patients in whom the origin could be identified.
PVCs and cardiomyopathy
Frequent PVCs can cause a cardiomyopathy that is reversible with radiofrequency ablation. This has been demonstrated in patients with idiopathic
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Dr. Bogun has received a grant from the Leducq Foundation.