Advertisement

Long-term mode and timing of premature ventricular complex recurrence following successful catheter ablation

  • Derek Lee
  • Kurt S. Hoffmayer
  • Jonathan C. Hsu
  • Amir Schricker
  • Ulrika Birgersdotter-Green
  • Farshad Raissi
  • Gregory K. Feld
  • David E. KrummenEmail author
MULTIMEDIA REPORT
First Online:
  • 8 Downloads

Abstract

Purpose

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.

Methods

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.

Results

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).

Conclusions

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.

Keywords

Premature ventricular contractions Catheter ablation Long-term follow-up Electroanatomic mapping 

Abbreviations

ECG

Electrocardiogram

PVC

Premature ventricular contraction

RVOT

Right ventricular outflow tract

LVOT

Left ventricular outflow tract

This is a preview of subscription content, log in to check access.

Notes

Financial support

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.

Author contributions

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.

Supplementary material

10840_2019_520_MOESM1_ESM.docx (21 kb)
ESM 1 (DOCX 21 kb)

References

  1. 1.
    Latchamsetty R, Bogun F. Premature ventricular complexes and premature ventricular complex induced cardiomyopathy. Curr Probl Cardiol. 2015;40:379–422.Google Scholar
  2. 2.
    Badhwar N, Scheinman MM. Idiopathic ventricular tachycardia: diagnosis and management. Curr Probl Cardiol. 2007;32:7–43.Google Scholar
  3. 3.
    Chugh SS, Shen WK, Luria DM, Smith HC. First evidence of premature ventricular complex-induced cardiomyopathy: a potentially reversible cause of heart failure. J Cardiovasc Electrophysiol. 2000;11:328–9.Google Scholar
  4. 4.
    Hoffmayer KS, Gerstenfeld EP. Diagnosis and management of idiopathic ventricular tachycardia. Curr Probl Cardiol. 2013;38:131–58.Google Scholar
  5. 5.
    Yarlagadda RK, Iwai S, Stein KM, Markowitz SM, Shah BK, Cheung JW, et al. Reversal of cardiomyopathy in patients with repetitive monomorphic ventricular ectopy originating from the right ventricular outflow tract. Circulation. 2005;112:1092–7.Google Scholar
  6. 6.
    Bala R, Garcia FC, Hutchinson MD, Gerstenfeld EP, Dhruvakumar S, Dixit S, et al. Electrocardiographic and electrophysiologic features of ventricular arrhythmias originating from the right/left coronary cusp commissure. Heart Rhythm : Off J Heart Rhythm Soc. 2010;7:312–22.Google Scholar
  7. 7.
    Bogun F, Crawford T, Reich S, Koelling TM, Armstrong W, Good E, et al. Radiofrequency ablation of frequent, idiopathic premature ventricular complexes: comparison with a control group without intervention. Heart Rhythm : Off J Heart Rhythm Soc. 2007;4:863–7.Google Scholar
  8. 8.
    Chinushi M, Aizawa Y, Ohhira K, Fujita S, Shiba M, Niwano S, et al. Repetitive ventricular responses induced by radiofrequency ablation for idiopathic ventricular tachycardia originating from the outflow tract of the right ventricle. Pacing Clin Electrophysiol : PACE. 1998;21:669–78.Google Scholar
  9. 9.
    Good E, Desjardins B, Jongnarangsin K, Oral H, Chugh A, Ebinger M, et al. Ventricular arrhythmias originating from a papillary muscle in patients without prior infarction: a comparison with fascicular arrhythmias. Heart Rhythm : Off J Heart Rhythm Soc. 2008;5:1530–7.Google Scholar
  10. 10.
    Jauregui Abularach ME, Campos B, Park KM, Tschabrunn CM, Frankel DS, Park RE, et al. Ablation of ventricular arrhythmias arising near the anterior epicardial veins from the left sinus of Valsalva region: ECG features, anatomic distance, and outcome. Heart Rhythm : Off J Heart Rhythm Soc. 2012;9:865–73.Google Scholar
  11. 11.
    John RM, Stevenson WG. Catheter-based ablation for ventricular arrhythmias. Curr Cardiol Rep. 2011;13:399–406.Google Scholar
  12. 12.
    Joshi S, Wilber DJ. Ablation of idiopathic right ventricular outflow tract tachycardia: current perspectives. J Cardiovasc Electrophysiol. 2005;16(Suppl 1):S52–8.Google Scholar
  13. 13.
    Kottkamp H, Chen X, Hindricks G, Willems S, Haverkamp W, Wichter T, et al. Idiopathic left ventricular tachycardia: new insights into electrophysiological characteristics and radiofrequency catheter ablation. Pacing Clin Electrophysiol : PACE. 1995;18:1285–97.Google Scholar
  14. 14.
    Kumagai K, Yamauchi Y, Takahashi A, Yokoyama Y, Sekiguchi Y, Watanabe J, et al. Idiopathic left ventricular tachycardia originating from the mitral annulus. J Cardiovasc Electrophysiol. 2005;16:1029–36.Google Scholar
  15. 15.
    Latif S, Dixit S, Callans DJ. Ventricular arrhythmias in normal hearts. Cardiol Clin. 2008;26:367–80 vi.Google Scholar
  16. 16.
    Movsowitz C, Schwartzman D, Callans DJ, Preminger M, Zado E, Gottlieb CD, et al. Idiopathic right ventricular outflow tract tachycardia: narrowing the anatomic location for successful ablation. Am Heart J. 1996;131:930–6.Google Scholar
  17. 17.
    Tada H, Ito S, Naito S, Kurosaki K, Kubota S, Sugiyasu A, et al. Idiopathic ventricular arrhythmia arising from the mitral annulus: a distinct subgroup of idiopathic ventricular arrhythmias. J Am Coll Cardiol. 2005;45:877–86.Google Scholar
  18. 18.
    Tada H, Tadokoro K, Ito S, Naito S, Hashimoto T, Kaseno K, et al. Idiopathic ventricular arrhythmias originating from the tricuspid annulus: prevalence, electrocardiographic characteristics, and results of radiofrequency catheter ablation. Heart Rhythm :Off J Heart Rhythm Soc. 2007;4:7–16.Google Scholar
  19. 19.
    Yamada T, McElderry HT, Doppalapudi H, Murakami Y, Yoshida Y, Yoshida N, et al. Idiopathic ventricular arrhythmias originating from the aortic root prevalence, electrocardiographic and electrophysiologic characteristics, and results of radiofrequency catheter ablation. J Am Coll Cardiol. 2008;52:139–47.Google Scholar
  20. 20.
    Yamada T, McElderry HT, Okada T, Murakami Y, Doppalapudi H, Yoshida N, et al. Idiopathic focal ventricular arrhythmias originating from the anterior papillary muscle in the left ventricle. J Cardiovasc Electrophysiol. 2009;20:866–72.Google Scholar
  21. 21.
    Betensky BP, Park RE, Marchlinski FE, Hutchinson MD, Garcia FC, Dixit S, et al. The V(2) transition ratio: a new electrocardiographic criterion for distinguishing left from right ventricular outflow tract tachycardia origin. J Am Coll Cardiol. 2011;57:2255–62.Google Scholar
  22. 22.
    Buxton AE, Waxman HL, Marchlinski FE, Simson MB, Cassidy D, Josephson ME. Right ventricular tachycardia: clinical and electrophysiologic characteristics. Circulation. 1983;68:917–27.Google Scholar
  23. 23.
    Dixit S, Gerstenfeld EP, Callans DJ, Marchlinski FE. Electrocardiographic patterns of superior right ventricular outflow tract tachycardias: distinguishing septal and free-wall sites of origin. J Cardiovasc Electrophysiol. 2003;14:1–7.Google Scholar
  24. 24.
    Hachiya H, Aonuma K, Yamauchi Y, Igawa M, Nogami A, Iesaka Y. How to diagnose, locate, and ablate coronary cusp ventricular tachycardia. J Cardiovasc Electrophysiol. 2002;13:551–6.Google Scholar
  25. 25.
    Ito S, Tada H, Naito S, Kurosaki K, Ueda M, Hoshizaki H, et al. Development and validation of an ECG algorithm for identifying the optimal ablation site for idiopathic ventricular outflow tract tachycardia. J Cardiovasc Electrophysiol. 2003;14:1280–6.Google Scholar
  26. 26.
    Lin D, Ilkhanoff L, Gerstenfeld E, Dixit S, Beldner S, Bala R, et al. Twelve-lead electrocardiographic characteristics of the aortic cusp region guided by intracardiac echocardiography and electroanatomic mapping. Heart Rhythm :Off J Heart Rhythm Soc. 2008;5:663–9.Google Scholar
  27. 27.
    Sekiguchi Y, Aonuma K, Takahashi A, Yamauchi Y, Hachiya H, Yokoyama Y, et al. Electrocardiographic and electrophysiologic characteristics of ventricular tachycardia originating within the pulmonary artery. J Am Coll Cardiol. 2005;45:887–95.Google Scholar
  28. 28.
    Yamada T, Doppalapudi H, McElderry HT, Okada T, Murakami Y, Inden Y, et al. Idiopathic ventricular arrhythmias originating from the papillary muscles in the left ventricle: prevalence, electrocardiographic and electrophysiological characteristics, and results of the radiofrequency catheter ablation. J Cardiovasc Electrophysiol. 2010;21:62–9.Google Scholar
  29. 29.
    Yamada T, Yoshida N, Murakami Y, Okada T, Muto M, Murohara T, et al. Electrocardiographic characteristics of ventricular arrhythmias originating from the junction of the left and right coronary sinuses of Valsalva in the aorta: the activation pattern as a rationale for the electrocardiographic characteristics. Heart Rhythm :Off J Heart Rhythm Soc. 2008;5:184–92.Google Scholar
  30. 30.
    Yoshida N, Yamada T, McElderry HT, Inden Y, Shimano M, Murohara T, et al. A novel electrocardiographic criterion for differentiating a left from right ventricular outflow tract tachycardia origin: the V2S/V3R index. J Cardiovasc Electrophysiol. 2014;25:747–53.Google Scholar
  31. 31.
    Baser K, Bas HD, Belardi D, Yokokawa M, Good E, Latchamsetty R, et al. Predictors of outcome after catheter ablation of premature ventricular complexes. J Cardiovasc Electrophysiol. 2014;25:597–601.Google Scholar
  32. 32.
    Zhang F, Yang B, Chen H, Ju W, Kojodjojo P, Cao K, et al. Noncontact mapping to guide ablation of right ventricular outflow tract arrhythmias. Heart Rhythm : Off J Heart Rhythm Soc. 2013;10:1895–902.Google Scholar
  33. 33.
    Lalani GG, Coysh T, Baykaner T, Zaman J, Hopper K, Schricker AA, et al. Organized sources are spatially conserved in recurrent compared to pre-ablation atrial fibrillation: further evidence for non-random electrical substrates. J Cardiovasc Electrophysiol. 2016;27:661–9.PubMedCentralGoogle Scholar
  34. 34.
    Dimitri H, Ng M, Brooks AG, Kuklik P, Stiles MK, Lau DH, et al. Atrial remodeling in obstructive sleep apnea: implications for atrial fibrillation. Heart Rhythm : Off J Heart Rhythm Soc. 2012;9:321–7.Google Scholar
  35. 35.
    Pathak RK, Middeldorp ME, Lau DH, Mehta AB, Mahajan R, Twomey D, et al. Aggressive risk factor reduction study for atrial fibrillation and implications for the outcome of ablation: the ARREST-AF cohort study. J Am Coll Cardiol. 2014;64:2222–31.Google Scholar
  36. 36.
    El Kadri M, Yokokawa M, Labounty T, Mueller G, Crawford T, Good E, et al. Effect of ablation of frequent premature ventricular complexes on left ventricular function in patients with nonischemic cardiomyopathy. Heart Rhythm : Off J Heart Rhythm Soc. 2015;12:706–13.Google Scholar
  37. 37.
    Nazarian S, Bluemke DA, Lardo AC, Zviman MM, Watkins SP, Dickfeld TL, et al. Magnetic resonance assessment of the substrate for inducible ventricular tachycardia in nonischemic cardiomyopathy. Circulation. 2005;112:2821–5.PubMedCentralGoogle Scholar
  38. 38.
    Wijeysundera HC, Hansen MS, Stanton E, Cropp AS, Hall C, Dhalla NS, et al. Neurohormones and oxidative stress in nonischemic cardiomyopathy: relationship to survival and the effect of treatment with amlodipine. Am Heart J. 2003;146:291–7.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Derek Lee
    • 1
    • 2
  • Kurt S. Hoffmayer
    • 1
    • 2
  • Jonathan C. Hsu
    • 1
    • 2
  • Amir Schricker
    • 1
    • 2
  • Ulrika Birgersdotter-Green
    • 1
    • 2
  • Farshad Raissi
    • 1
    • 2
  • Gregory K. Feld
    • 1
    • 2
  • David E. Krummen
    • 1
    • 2
    Email author
  1. 1.Department of Medicine, Division of CardiologyUniversity of California San DiegoSan DiegoUSA
  2. 2.VA San Diego Healthcare SystemSan DiegoUSA

Personalised recommendations

Cite article

Buy options