CA-531-02 ABLATION OF PREMATURE VENTRICULAR CONTRACTIONS: DISSOCIATION BETWEEN ACUTE AND LONG-TERM OUTCOMES

Abstract

Acute and long-term outcomes after premature ventricular contraction (PVC) ablation may vary with structural heart disease (SHD) and PVC origin. To compare acute and long-term outcomes after PVC ablation according to SHD and origin. We reviewed 213 consecutive patients who underwent PVC ablation. Acute success was defined as abolition of the target PVC. Follow-up included 12 lead electrocardiographic, ambulatory monitoring, and symptoms. The origin of PVC was defined by mapping and elimination by ablation. Of 213 patients, 125 (59%) had structural heart disease (SHD) (coronary disease in 42, cardiomyopathy in 64, valve disease in 19). Acute ablation success was achieved in 93% of patients. During long-term follow-up (391 ± 253 days), 20% of patients recurred. After acute failure, late success occurred in 6 of 14 (43%). In patients with SHD, the long-term recurrence rate was higher compared to patients without SHD (26% vs 11%; P<0.05), but the acute ablation success rate was similar (92% vs 95%; P=0.31)(Figure 1). Outcome varied with PVC origin (Figure 2). Long-term success was greater in patients with outflow tract (RVOT and LVOT) PVCs than for other PVC origins (85 % vs 67%; P=0.001) despite similar acute ablation success rates (93% vs 91%; P=0.70). Thirty seven (17%) patients had PVCs from more than 1 segment. Acute success (96% vs 84%; P<0.05) and long-term outcome (82% vs 68%; P<0.05) were better for patients with PVCs from only one versus multiple segments. In patients with PVCs, the acute effect of ablation predicts the long-term outcome, but with limited accuracy, particularly in patients with structural heart disease and PVCs from multiple origins. Late success after acute failure occasionally occurs.