Relative efficacy of catheter ablation vs antiarrhythmic drugs in treating premature ventricular contractions: a single-center retrospective study

Abstract

Background: It is unknown whether radiofrequency ablation (RFA) or antiarrhythmic therapy is superior when treating patients with symptomatic premature ventricular contractions (PVCs).

Objective: To determine the relative efficacy of RFA and antiarrhythmic drugs (AADs) on PVC burden reduction and increasing left ventricular systolic function.

Methods: Patients with frequent PVCs (>1000/24 h) were treated either by RFA or with AADs from January 2005 through December 2010. Data from 24-hour Holter monitoring and echocardiography before and 6-12 months after treatment were compared between the 2 groups.

Results: Of 510 patients identified, 215 (40%) underwent RFA and 295 (60%) received AADs. The reduction in PVC frequency was greater by RFA than with AADs (-21,799/24 h vs -8,376/24 h; P < .001). The left ventricular ejection fraction (LVEF) was increased significantly after RFA (53%-56%; P < .001) but not after AAD (52%- 52%; P = .6) therapy. Of 121 (24%) patients with reduced LVEF, 39 (32%) had LVEF normalization to 50% or greater. LVEF was restored in 25 of 53 (47%) patients in the RFA group compared with 14 of 68 (21%) patients in the AAD group (P = .003). PVC coupling interval less than 450 ms, less impaired left ventricular function, and RFA were independent predictors of LVEF normalization performed by using multivariate analysis.

Conclusion: RFA appears to be more effective than AADs in PVC reduction and LVEF normalization.

Keywords: AAD; Antiarrhythmic drug; CAD; CCB; DCM; ECG; ICM; LV; LVEDD; LVEF; LVESD; LVOT; Left ventricular dysfunction; NSVT; PVC; PVC-CMP; Premature ventricular contraction; Premature ventricular contraction–induced cardiomyopathy; RFA; RV; RVOT; Radiofrequency catheter ablation; antiarrhythmic drug; calcium channel blocker; coronary artery disease; dilated cardiomyopathy; electrocardiogram; ischemic cardiomyopathy; left ventricular ejection fraction; left ventricular end-diastolic dimension; left ventricular end-systolic dimension; left ventricular outflow tract; left ventricular/ventricle; nonsustained ventricular tachycardia; premature ventricular contraction; premature ventricular contraction–induced cardiomyopathy; radiofrequency ablation; right ventricular outflow tract; right ventricular/ventricle.