Abstract 12935: Predictors of Long-term Success After Catheter Ablation of Premature Ventricular Complexes

Abstract

Introduction: Some patients(pts) have late recurrence after acutely successful radiofrequency catheter ablation(RFCA) of premature ventricular complexes (PVC). Hypothesis: The aim of this study was to evaluate predictors of long term success following acutely successful PVC ablation. Methods: From 2016-19, we identified consecutive pts at our institution with frequent PVCs undergoing RFCA and reviewed procedural data and medical records. Earliest local activation on the intracardiac bipolar and unipolar electrogram was measured using digital calipers. Acute success was defined as elimination of targeted PVC for at least 30 mins after RFCA. Long term success was defined as absence of PVC on 12 lead ECG during all follow up (f/u) visits and PVC burden reduction >80% or PVC burden <5% on f/u monitoring at 1 year. Results: Among 241 pts, 161 (66.8%) pts had long term success with mean f/u of 17.6±5.8 months.In univariate analysis, diabetes mellitus and alcohol use were associated with PVC recurrence while age, female sex, acute success, ablation time, right ventricular PVC origin, single PVC morphology (sPVC), and earliest bipolar activation>24msec pre-QRS were associated with long-term success. In multivariate analysis, female sex, sPVC and earliest activation >24 msec preQRS were independent predictors of long term success at 1 year. The positive predictive value of earliest bipolar onset preQRS of PVC>24msec for long term success was 0.77(P<0.001). Negative predictive value of earliest onset preQRS <15msec for long term success was 0.86(P=0.003), suggesting that ablation when the local bipolar electrogram preceded the QRS by <15ms was unlikely to result in long term success. Conclusions: Female gender, sPVC, and earliest onset of bipolar electrogram preQRS>24msec were predictors of long term success in patients with PVC undergoing RFCA. If local onset is <15ms, RF ablation is not worthwhile. The reason for improved outcome in females requires further study.