Recovery of renal dysfunction after catheter ablation of outflow tract ventricular arrhythmias in patients with ventricular premature depolarization-mediated cardiomyopathy

Abstract

Purpose: Frequent ventricular premature depolarizations (VPDs) may cause cardiomyopathy (VPDCM), which often improves after VPD suppression. This study aimed to evaluate whether ablation of outflow tract ventricular arrhythmias (OT VAs) in patients with VPDCM improves renal in addition to left ventricular (LV) function.

Methods: We retrospectively evaluated 153 patients with OT VAs and examined VPD burden and LV ejection fraction (LVEF), as well as estimated glomerular filtration rate (eGFR) pre- and post-ablation. LV dysfunction was defined as LVEF <50 % and impaired renal function was defined as eGFR of <60 mL/min/1.73m².

Results: Fifty-five patients had VPDCM. During mean follow-up of 14 months, 140 (92 %) were free from arrhythmia. In patients with VPDCM, patients with baseline LVEF 40-50 % had greater improvement in the post-ablation LVEF compared to patients with baseline LVEF <40 % (p < 0.01). At baseline, 36 (72 %) patients had renal dysfunction, 29 (81 %) of whom had improvement in eGFR from baseline after successful ablation from eGFR 51 to 57 mL/min/1.73m². There was a significant association between cardiac (ΔLVEF ≥10 %) and renal (ΔeGFR ≥10 %) improvement (r = 0.54, p = 0.04). Using logistic regression analysis, procedural success was an independent predictor of improvement of cardiac (odds ratio [OR] = 13.7, p = 0.03) and renal function (OR = 21.0, p = 0.047).

Conclusions: Successful catheter ablation of OT VA reduces VPD burden and is associated with improved cardiac and renal function in patients with VPDCM.

Keywords: Catheter ablation; Chronic kidney disease; Outflow tract ventricular arrhythmias; Ventricular premature depolarization.