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Predictors of adequate intraprocedural premature ventricular complex (PVC) frequency during idiopathic PVC ablation

Prädiktoren einer ausreichenden PVC(„premature ventricular complex“)-Frequenz während der Ablation bei idiopathischen PVCs

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Abstract

Background

The aim of the present study was to determine the predictors of adequate intraprocedural premature ventricular complex (PVC) frequency for successful mapping and ablation of idiopathic PVCs.

Methods

A total of 101 consecutive patients (45 men; age: 47.9 ± 14.2 years) who had undergone idiopathic PVC ablation between 01 November 2018 and 24 June 2020 constituted our study population. Clinical and demographic data, procedural details and 24 h rhythm recordings that had been recorded before the procedure were retrospectively evaluated. Total PVC burden and diurnal variability assessed by the ratio of night time (22:00–06:00) over day time (06:00–22:00) PVC burden was calculated. The relationship between hourly PVC number and heart rate was also evaluated for each patient. Clinical characteristics and Holter parameters were compared between groups with and without adequate intraprocedural frequency of PVCs that permitted activation mapping.

Results

In all, 27 patients (26.7%) had infrequent intraprocedural PVCs which necessitated isoproterenol infusion or cancellation of ablation procedure due to inability of activation mapping. PVC burden was significantly higher in the group with frequent intraprocedural PVCs (26.1 ± 9.4% vs 21.2 ± 10.3%; p: 0.026). There were no significant differences between groups regarding the relationship between hourly PVC number and heart rate or the ratio of night/day PVC burden. Binary logistic regression analysis revealed the 24 h Holter PVC burden as the sole parameter that is significant predictor of frequent intraprocedural PVCs permitting activation mapping.

Conclusion

The 24 h PVC burden was the only predictor of adequate intraprocedural PVC frequency permitting activation mapping during idiopathic PVC ablation.

Zusammenfassung

Hintergrund

Ziel der vorliegenden Studie war es, Prädiktoren für eine adäquate intraprozedurale PVC(„premature ventricular complex“)-Frequenz für ein erfolgreiches Mapping und eine Ablation wegen idiopathischer PVCs zu bestimmen.

Methoden

Insgesamt 101 konsekutive Patienten (45 Männer; Alter: 47,9 ± 14,2 Jahre), die sich zwischen dem 01. November 2018 und dem 24. Juni 2020 einer Ablation wegen idiopathischer PVCs unterzogen hatten, bildeten das Studienkollektiv. Klinische und demographische Daten, Einzelheiten zum Verfahren und vor dem Eingriff erstellte 24-Stunden-Rhythmusaufzeichnungen wurden retrospektiv ausgewertet. Ermittelt wurden dabei die PVC-Belastung insgesamt und die tageszeitliche Variabilität, bewertet anhand des Quotienten aus PVCs während der Nacht (22:00-06:00 Uhr) und während des Tages (06:00-22:00). Auch die Beziehung zwischen der Anzahl der PVCs pro Stunde und der Herzfrequenz wurde für jeden Patienten ausgewertet. Klinische Charakteristika und Holter-Parameter wurden verglichen zwischen Gruppen mit und ohne für ein Aktivierungsmapping adäquate PVC-Frequenz während des Eingriffs.

Ergebnisse

Insgesamt 27 Patienten (26,7 %) hatten während des Eingriffs eine so niedrige PVC-Frequenz, dass aufgrund der Unmöglichkeit des Aktivierungsmappings eine Isoproterenol-Infusion oder ein Abbruch des Ablationsverfahrens erforderlich war. Die PVC-Belastung war in der Gruppe mit häufigen intraprozeduralen PVCs signifikant höher (26,1 ± 9,4 vs. 21,2 ± 10,3 %; p = 0,026). Es gab keine signifikanten Unterschiede zwischen den Gruppen hinsichtlich der Beziehung zwischen PVCs pro Stunde und der Pulsfrequenz oder des Quotienten aus Nacht- und Tages-PVC-Belastung. In der binären logistischen Regressionsanalyse erwies sich die 24-Stunden-Holter-PVC-Belastung als der einzige Parameter, der einen signifikanten Prädiktor darstellt für die PVC-Frequenz, die während des Eingriffs ein Aktivierungsmapping erlaubt.

Schlussfolgerung

Die 24-Stunden-PVC-Belastung war der einzige Prädiktor für eine PVC-Frequenz, die ausreichend war, um ein Aktivierungsmapping während einer Ablation bei idiopathischen PVCs zu ermöglichen.

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Authors and Affiliations

  1. Cardiology Clinic, Kartal Kosuyolu High Speciality Educational and Research Hospital, Istanbul, Turkey

    Serdar Demir M.D., Kamil Gulsen M.D., Abdulkadir Uslu M.D., Ayhan Kup M.D. &  Taylan Akgun

  2. Department of Cardiology, Marmara University School of Medicine, Istanbul, Turkey

    Alper Kepez,  Batur Gonenc Kanar & Cagan Yildirim M.D.

  3. Cardiology Clinic, Mardin Kiziltepe State Hospital, Mardin, Turkey

    Fethullah Kayan M.D.

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  1. Serdar Demir M.D.
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  2. Kamil Gulsen M.D.
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  3. Alper Kepez
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  4. Abdulkadir Uslu M.D.
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  6. Batur Gonenc Kanar
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Correspondence to Alper Kepez.

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Conflict of interest

S. Demir, K. Gulsen, A. Kepez, A. Uslu, A. Kup, B.G. Kanar, F. Kayan, C. Yildirim and T. Akgun declare that they have no competing interests.

All procedures performed in studies involving human participants or on human tissue were in accordance with the ethical standards of the institutional and/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Demir, S., Gulsen, K., Kepez, A. et al. Predictors of adequate intraprocedural premature ventricular complex (PVC) frequency during idiopathic PVC ablation. Herz 46, 476–481 (2021). https://doi.org/10.1007/s00059-020-05017-8

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  • DOI: https://doi.org/10.1007/s00059-020-05017-8

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