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Observational Study
. 2023 May 19;25(5):euad038.
doi: 10.1093/europace/euad038.

Best ablation strategy in patients with premature ventricular contractions with multiple morphology: a single-centre experience

Sanghamitra Mohanty  1 , John D Burkhardt  1 , Luigi Di Biase  1   2 , Prasant Mohanty  1 , Sai Shishir Shetty  1 , Carola Gianni  1 , Domenico G Della Rocca  1 , Karim K Baho  1 , Trevor Morris  1 , Angel Mayedo  1 , Bryan MacDonald  1 , Amin Al-Ahmad  1 , Mohamed Bassiouny  1 , Gerald Joseph Gallinghouse  1 , Rodney Horton  1 , Andrea Natale  1   3   4
Affiliations
Observational Study

Best ablation strategy in patients with premature ventricular contractions with multiple morphology: a single-centre experience

Sanghamitra Mohanty et al. Europace. .

Abstract

Aims: This study aimed to examine the clinical benefits of targeted ablation of all Premature ventricular complex (PVC) morphologies vs. predominant PVC only.

Methods and results: A total of 171 consecutive patients with reduced left ventricular ejection fraction (LVEF) and ≥2 PVC morphology with high burden (>10%/day) undergoing their first ablation procedure were included in the analysis. At the initial procedure, prevalent PVC alone was ablated in the majority. However, at the redo, all PVC morphologies were targeted for ablation. : At the first procedure, 152 (89%) patients received ablation of the dominant PVC only. In the remaining 19 (11%) patients, all PVC morphologies were ablated. At two years, high PVC burden was detected in 89 (52%) patients. Repeat procedure was performed in 78 of 89, where all PVC morphologies were ablated. At 5 years after the repeat procedure, 71 (91%) had PVC burden of <5% [3.8 ± 1.1% vs. 15.4 ± 4.3% in successful vs. failed subjects (P < 0.001)]. In patients with low PVC burden after the initial procedure, LVEF improved from 37.5% to 41.6% [mean difference (MD): 3.39 ± 2.9%, P < 0.001], whereas a reduction in LVEF from 39.8% to 34.5% (MD: 6.45 ± 4.7%, P < 0.001) was recorded in patients with high PVC burden. One year after the repeat procedure, LVEF improved from 36.2% to 41.7% (MD: 5.5 ± 4.3%, P < 0.001) in patients with successful ablation.

Conclusion: In this observational series, ablation of all PVC morphologies was associated with significantly lower PVC burden and improvement of LVEF at long-term follow-up, compared with ablation of the dominant morphology only.

Keywords: LVEF; Morphology; PVC ablation; PVC burden; Premature ventricular complex (PVC).

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Conflict of interest statement

Conflict of interest: A.N. is a consultant for Abbott, Baylis, Biotronik, Biosense Webster, Boston Scientific, and Medtronic. L.D.B.: Consultant/Advisory Board: Biosense Webster, Hansen Medical, Abbott, Baylis Medical, Biotronik, Boston Scientific, Janssen, Medtronic, Pfizer Inc., Stereotaxis, and Zoll Medical. The other authors have no relevant COI to disclose.

Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
Example of a patient with multiple PVCs: PVC#1 (top circle), originating from the LVOT (below the left coronary cusp, near the mitral valve annulus), and PVC#2 (bottom circle), originating from the left infero-septal PM. From left to right, ECG; Carto3 point-by-point electroanatomical maps (LAO and RAO projections) of the RVOT (partially transparent), LVOT (bottom), and aortic root/left coronary cusp (top) showing the ablation lesions at the two separate sites of successful ablation; and fluoroscopic view (AP projection) of the ablation catheter at the site of successful ablation. AP, anteroposterior; ECG, electrocardiogram; LAO, left anterior oblique; LVOT, left ventricular outflow tract; PM, papillary muscle; PVC, premature ventricular contraction; RAO, right anterior oblique; RVOT, right ventricular outflow tract.
Figure 2
Figure 2
Electroanatomic map showing three PVC morphologies (A: postero-medial papillary muscle, B: antero-lateral papillary muscle, and C: left coronary cusp) in Participant II.
Figure 3
Figure 3
Bar diagram shows change in LVEF after the first procedure. In patients with successful ablation after the initial procedure, LVEF improved from 37.5% to 41.6% [mean difference (MD): 3.39 ± 2.9%, P < 0.001], whereas a reduction in LVEF from 39.8% to 34.5% (MD: 6.45 ± 4.7%, P < 0.001) was recorded in patients with high PVC burden. LVEF, left ventricular ejection fraction; PVC, premature ventricular complex.
Figure 4
Figure 4
Flowchart shows the main results summarized.
See this image and copyright information in PMC

Comment in

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