628 Radiofrequency Catheter Ablation for Disabling Frequent Premature Ventricular Contractions: A Single-Center Experience

Abstract

Radiofrequency (RF) ablation for frequent premature ventricular contractions (PVCs) has generally been performed in cases associated with tachycardiomyopathy. There are scant data concerning PVCs ablation only for disabling palpitations. Nineteen consecutive pts were included (47±18 years, 11 women). Left ventricular (LV) ejection fraction was 53±11% (<45% in 4 pts, of whom 2 with coronary artery disease). Seventeen pts presented with disabling palpitations (3 with syncope), 1 asymptomatic pt was ablated for mild LV enlargement, and 1 for family history of sudden cardiac death. Two pts had previous right ventricular (RV) outflow tract ventricular tachycardia (VT). Anti-arrhythmic drugs (AADs) were ineffective in 10 pts or associated with intolerance/side effects in 7, while 2 pts declined AADs for planned pregnancy. Mapping was performed in RV in 8 pts, in LV through retrograde access in 6 and through transseptal access in 2, and in both ventricles in 3. Post-ablation pts underwent 24h Holter recording within 3 months. Success was defined as ≥80% reduction in PVCs burden. Baseline PVCs burden on 24h Holter recording was 21±15%. In 13 pts, non-sustained VTs were also recorded. All pts were non-inducible for sustained VT during the procedure. In 4 pts, ablation was performed using solely pace-mapping (absent or rare PVCs). Voltage electronatomical mapping detected a zone of low-voltage/scar in the chamber of interest in 9 pts. PVCs location was in the RV in 8 pts (RV outflow tract in 7, para-hisian in 1), and in the LV in 11 (of whom LV outflow tract in 1, peri-mitral in 2, aortic cups in 1). Procedure and fluoroscopy times were 167±61 min and 15±8 min, respectively. Total RF application time was 9±6 min, and number of RF applications 11±7. Acute procedure completely suppressed PVCs in 13 pts, partially in 2, while there was no PVCs suppression in the remaining 4. PVCs burden decreased from 21±15% to 7±9% (p<0.001). During follow-up, success was achieved in 12 pts (63%). There were 3 minor complications: 2 pericardial effusions medically treated, and an arterio-venous fistula that did not require surgery. The only variable significantly correlated with success was the absence of polymorphic PVCs (≥2 morphologies). Success was achieved in 9/11 pts (82%) with monomorphic PVCs and in 3/8 pts (38%) with polymorphic PVCs (p=0.048). PVCs ablation for disabling symptoms is feasible and safe. Monomorphic PVCs are associated with better success rate compared to polymorphic PVCs.