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. 2024 Feb 20;14(2):e081815.
doi: 10.1136/bmjopen-2023-081815.

Outcomes of single-procedure radiofrequency catheter ablation for idiopathic ventricular arrhythmias: a single-centre retrospective cohort study

Zhi Jiang #  1   2 , Chuxian Guo #  3 , Qifang Liu  1   2 , Ye Tian  1   2 , Longhai Tian  1   2 , Ying Yang  1   2 , Junxian Wang  1   2 , Chunyan Chen  1   2 , Yaxi Zheng  1   2 , Yu Li  3 , Qiaoqiao Ou  3 , Long Yang  4   2   3
Affiliations

Outcomes of single-procedure radiofrequency catheter ablation for idiopathic ventricular arrhythmias: a single-centre retrospective cohort study

Zhi Jiang et al. BMJ Open. .

Abstract

Objectives: Radiofrequency catheter ablation is the first-line treatment for idiopathic premature ventricular complexes (PVCs) and ventricular tachycardias (VTs). However, the outcomes were less compared among the categories. The study aims to assess the effectiveness and safety of catheter ablation for idiopathic PVC/VTs in a single high-volume centre, using the right ventricular outflow tract (RVOT) as a reference.

Design: Retrospective cohort study.

Setting: Patient data were collected from a tertiary hospital in Guizhou, China.

Participants: Between September 2013 and September 2022, 1028 patients (male: 41.3%; age: 46.5±15.6 years) who underwent the first catheter ablation for idiopathic monomorphic PVC/VTs were enrolled.

Outcome measures: Acute success, procedure-related complications, and long-term recurrence were assessed. Antiarrhythmic drugs (AADs) were not administrated after procedures unless recurrence was identified.

Results: The overall acute success rate was 90.3%, with 368 patients (35.8%) experiencing left ventricular PVC/VTs. No cases of third-degree atrioventricular block or death were reported. Complications were more common in patients with left ventricular PVC/VTs than those with right-sided ones (4.6% vs 0.1%, p<0.001). A total of 926 patients (90.1%) were followed up for an average of 9.7±3.7 months, and only the PVC/VTs category was found to be associated with long-term success rates. The RVOT, endocardial left ventricular outflow tract (endoLVOT), tricuspid annulus (TA) free wall, posterior septum and fascicular VT had long-term success rates exceeding 85%. Other types of PVC/VTs showed significantly higher risks of recurrence.

Conclusions: Besides RVOT and fascicular VT, single-procedure catheter ablation without AADs is highly effective for endoLVOT, TA-free wall and posterior septum. Patients with left ventricular PVC/VTs have higher complication risks compared with right ones.

Keywords: Cardiac Epidemiology; Cardiology; Pacing & electrophysiology.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Patient flowchart. EF, ejection fraction; endoLVOT, endocardial left ventricular outflow tract; LV, left ventricle; PVC premature ventricular complex; RV, right ventricle; RVOT, right ventricular outflow tract; VT, ventricular tachycardia.
Figure 2
Figure 2
Categorisation and representative 12-leads electrocardiography of right (A) and left (B) ventricular PVC/VTs. The origins are annotated by the circled numbers on the figures. The acute success rates are annotated as numbers (%) beneath the categories. APM, anterior papillary muscle; ASS, anterior superior septum; endoLVOT, endocardial left ventricular outflow tract; LAF, left anterior fascicle; LPF, left posterior fascicle; MB, moderator band; PPM, posterior papillary muscle; PVC, premature ventricular complex; RB, right bundle branch; RVFW, right ventricular free wall; RVOT, right ventricular outflow tract; SPM, septal papillary muscle; TA, tricuspid annulus; VT, ventricular tachycardia.
Figure 3
Figure 3
Kaplan-Meir analysis on long-term success among PVC/VT categories. The long-term success rates are annotated as percentages following the categories. endoLVOT, endocardial left ventricular outflow tract; LV, left ventricle; PVC premature ventricular complex; RV, right ventricle; RVOT, right ventricular outflow tract; TA, tricuspid annulus; VT, ventricular tachycardia.
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