Catheter ablation in patients with pleomorphic, idiopathic, premature ventricular complexes

Abstract

Premature ventricular complexes (PVCs) often originate from multiple locations. The goals of this study were to assess characteristics of patients with pleomorphic, idiopathic PVCs and to determine the impact of pleomorphic PVCs on outcomes. Records were collected from 153 consecutive patients referred for ablation of PVCs. Patients with structural heart disease (n = 34) or inadequate ambulatory electrocardiographic data (n = 19) were excluded. Among 100 consecutive patients (age 52 ± 15 years, 53% men, 31% pleomorphic vs 69% monomorphic) referred for ablation of idiopathic PVCs, the success rate was lower in patients with pleomorphic PVCs than in those with monomorphic PVCs (71% vs 90%, P = .017, overall 84%). The presence of pleomorphic PVCs was independently associated with unsuccessful ablation. A cutoff of ≥156 nonpredominant PVCs over 24 hours best differentiated successful from unsuccessful ablation procedures (area under the curve 0.64, sensitivity 56%, specificity 74%). Pleomorphic PVCs more often had an epicardial origin than did monomorphic PVCs (29% vs 9%, P = .008). Repeat ablation procedures were required in 20 patients (20%; 6 had pleomorphic PVCs). Of these 20 patients, 16 (80%) had recurrence of the former predominant PVC, 3 patients (15%) had an increase of a nonpredominant PVC, and 1 patient (5%) had a newly emerging PVC focus. The presence of pleomorphic PVCs affects ablation outcomes. Successful elimination of the predominant PVC often results in successful ablation, even if not all PVCs are targeted. Although pleomorphic PVCs infrequently require repeat ablation procedures, most recurrences are due to reemergence of the originally targeted predominant PVC morphology.