P1371Catheter-induced premature ventricular complexes (pvc) may aid in the determination of optimal timing for clinical pvc ablation

Abstract

Abstract Background There is significant interpatient variability regarding the timing of the earliest local activation relative to surface QRS during premature ventricular complex (PVC) ablation. The aim of the present study is to evaluate whether catheter-induced premature ventricular complexes (PVCs) produced at the presumptive ablation site may aid in the identification of the optimal timing of the earliest local activation for the successful ablation of clinical PVCs. Methods Sixty-three consecutive patients (35 males, age: 53.5 ± 14.4 years) without any exclusion criteria who had undergone PVC ablation between 01/07/2018 and 01/07/2019 constituted our study population. Catheter-induced PVCs were generated at the site with presumptive PVC origin according to the ECG criteria during the procedure of PVC ablation. Five PVCs were induced by mechanical stimulation in separate points, and the time interval between the beginning of EGM at catheter tracing and the beginning of the QRS complex of each catheter-induced PVC was noted. The mode of five time intervals (Cath EGM-ECG) was used in the analysis. The time interval between the beginning of local EGM of clinical PVCs at the earliest site and the beginning of the QRS complex of clinical PVCs (PVC earliest EGM-ECG) was also noted. The value of Cath EGM-ECG as a reference for procedural success of ablation was evaluated by examining the relationship between Cath EGM-ECG and PVC earliest EGM-ECG. Results Fifty-two patients had successful ablation, and 43 of them (82.7%) had PVC earliest EGM-ECG values greater than or equal to Cath EGM-ECG. Eleven patients had procedural failure, and all of them had PVC earliest EGM-ECG values lower than Cath EGM-ECG (Table 1). A PVC earliest EGM-ECG value -1.5 ms greater than Cath EGM-ECG predicted successful ablation with a sensitivity of 90.4% and a specificity of 100.0% in the general patient population (Figure 1). Conclusion The results of the present study indicate that catheter-induced PVCs generated at the site of the presumptive source of origin of clinical PVCs may guide the timing of the earliest site during clinical PVC ablation. Further studies are required to validate our results and test the predictive value of Cath EGM- ECG interval for long-term success of PVC ablation. Table 1 PVC earliest EGM-ECG < Cath EGM- ECG PVC earliest EGM-ECG ≥ Cath EGM- ECG Ablation successful (n:52) 9 (17.3%) 43 (82.7%) Ablation not successful (n:11) 11 (100.0%) 0 (0%) Outcome of ablation in general patient population according to the relationship between PVC earliest EGM-ECG and Cath EGM- ECG Abstract Figure 1