Elsevier

Heart Rhythm

Volume 12, Issue 4, April 2015, Pages 706-713
Heart Rhythm

Effect of ablation of frequent premature ventricular complexes on left ventricular function in patients with nonischemic cardiomyopathy

https://doi.org/10.1016/j.hrthm.2014.12.017Get rights and content

Background

Frequent idiopathic premature ventricular complexes (PVCs) can result in PVC-induced cardiomyopathy. Frequent PVCs can also aggravate ischemic cardiomyopathy.

Objective

The purpose of this study was to investigate the impact of frequent PVCs on nonischemic cardiomyopathy.

Methods

This was a consecutive series of 30 patients (mean age 59.1 ± 12.1; 18 men; mean ejection fraction [EF] 38% ± 15%) with structurally abnormal hearts based on the presence of scar on cardiac magnetic resonance imaging and/or a history of cardiomyopathy before the presence of frequent PVCs who were referred for ablation of frequent PVCs.

Results

Ablation was successful in 18 of 30 patients (60%), resulting in an increase of mean EF from 33.9% ± 14.5% to 45.7% ± 17% (P < .0001) during mean follow-up of 30 ± 28 months. The PVC burden in these patients was reduced from 23.1% ± 8.8% to 1.0% ± 0.9% (P < .0001). Mean EF did not change in patients with a failed ablation procedure (44.4 ± 16 vs 43.5 ± 21, P = .85). The PVC site of origin was in scar tissue in 14 of 18 patients with a successful ablation procedure. Mean New York Heart Association functional class improved from 2.3 ± 0.6 to 1.1 ± 0.2 (P < .0001) in patients with a successful outcome and remained unchanged in patients with an unsuccessful outcome (1.9 ± 0.9 vs 1.9 ± 0.7, P = 1).

Conclusion

In patients with frequent PVCs and nonischemic cardiomyopathy, EF and functional class can be improved but not always normalized by successful PVC ablation. In most patients with an effective ablation, the arrhythmogenic substrate was located in scar tissue.

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.

Section snippets

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

References (13)

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Dr. Bogun has received a grant from the Leducq Foundation.

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