Long-term mode and timing of premature ventricular complex recurrence following successful catheter ablation
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Catheter ablation of premature ventricular contractions (PVCs) is highly successful and has become the hallmark treatment for symptomatic or highly prevalent cases. However, few studies exist that evaluate the outcomes of ablation and likely mechanisms of PVC recurrence beyond 1 year of follow-up.
This study is a retrospective analysis of patients who underwent catheter ablation for symptomatic PVCs with acute procedural success and had clinical follow-up ≥ 12 months.
Forty-four patients (24 women; age 53.5 ± 4.8 years) following acutely successful PVC ablation with long-term follow-up were studied. At a mean of 36 ± 6 months, overall long-term ablation success was 75% (33/44 patients). Notably, recurrence of the targeted PVC focus was low (6.8%, 3/44 patients); the majority of recurrences were from a new source location (18.2%, 8/44 patients). The time course for targeted versus de novo PVC recurrences was significantly different: recurrence of a PVC similar to the targeted PVC morphology occurred at a mean of 5.0 ± 2.0 months, while recurrence of a PVC different from the index case occurred at a mean of 35.8 ± 17.1 months (p = 0.01). Non-ischemic cardiomyopathy was associated with increased risk of PVC recurrence (odds ratio [OR] 14.50 (95% confidence interval [CI] 1.92–109.33, p = 0.01)) and was a significant negative prognostic factor in multivariate analysis for PVC recurrence survival (hazard ratio [HR] 4.63, 95% CI 1.03–20.74, p = 0.04).
The majority of long-term PVC recurrences occur late in follow-up, at locations remote from the targeted PVC source or sources. Such sites may represent ongoing substrate evolution; additional work is required to determine the precise substrate alterations which promote such arrhythmogenic changes.
KeywordsPremature ventricular contractions Catheter ablation Long-term follow-up Electroanatomic mapping
Premature ventricular contraction
Right ventricular outflow tract
Left ventricular outflow tract
This study was financially supported by the UCSD Clinical Translational Research Institute (GEM Grant), the University of California Center for Accelerated Innovation, the UCSD Rady MEET Grant to DEK, and National Institutes of Health (Grant 5T35HL007491) to DL.
Derek Lee: Data analysis/interpretation, drafting article, statistics.
Kurt S. Hoffmayer: Critical revision of article, statistics, approval of article.
Jonathan C. Hsu: IRB approval secured by, data collection, approval of article.
Amir Schricker: Data generation, approval of article.
Ulrika Birgersdotter-Green: Critical revision of article, approval of article.
Farshad Raissi: Data generation, approval of article.
Gregory K. Feld: Data generation, approval of article.
David E. Krummen: Funding secured by, concept/design, data generation, drafting article, critical revision of article, approval of article.
Compliance with ethical standards
This study was conducted under an institution review board-approved protocol for the retrospective analysis of patients following catheter ablation at the University of California San Diego Medical Center.
Conflict of interest
Lee: This author declares that he has no conflict of interest.
Hsu: Honoraria from Medtronic, St. Jude Medical, Boston Scientific, and Biotronik. Consulting for 3DT Holdings. Research grants from Biotronik, Biosense Webster.
Feld: Equity and Board of Directors for Perminova, Inc.
Krummen: Consulting for Abbott Laboratories. Equity in Vektor Medical.
Hoffmayer, Schricker, Hsu, Birgersdotter-Green, Raissi, Feld, and Krummen: EP Fellowship support from Abbott Laboratories, Biosense Webster, Biotronik, Boston Scientific, and Medtronic.
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