PO-623-02 OUTCOME OF REPEAT ABLATION FOR PREMATURE VENTRICULAR CONTRACTIONS IN PATIENTS WITH PRIOR ABLATION FAILURE: IMPACT OF ADVANCED TECHNIQUES

Abstract

The utility of advanced ablation (investigational needle ablation, epicardial, and simultaneous two site unipolar radiofrequency ablation) for premature ventricular contractions (PVCs) in patients with prior ablation failure is not clear. To evaluate long-term outcomes of advanced ablation techniques in patients who failed prior PVC ablation. We reviewed 239 consecutive patients who underwent PVC ablation. When standard endocardial ablation with normal or half normal saline failed, we considered an advanced ablation technique. Acute success was defined as abolition of the target PVC. Follow-up included 12 lead electrocardiographic, ambulatory monitoring, and symptoms. Of 239 patients, 75 (31%) patients had failed a prior ablation procedure and they more often had LVOT PVCs (Table). Despite failing prior ablation, repeat standard ablation was acutely successful in 59%, and 75% of these patients had long-term success. Standard ablation acute success rate was lower and long-term recurrence rate was higher compared to patients without prior ablation (59% vs 95%; P<0.001, 29% vs 17%; P<0.05, respectively)(Figure 1). Of the 31 repeat standard procedures that again failed, advanced techniques were performed in 23 (16 Needle, 5 epicardial and 2 simultaneous ablation) and were acutely successful in 16 (70%) with long-term success in 14 (45%). Overall long-term success for patients with prior failed standard ablation was 71%. Although success is lower for patients with prior failed ablation, repeat ablation appears reasonable for many as repeat ablation with normal or half normal saline irrigation is successful in 59% and use of advanced techniques increased success to 71% in this group.