Features of patients with premature ventricular complex ablation: single center case series

Year 2021, Volume: 7 Issue: 2, 159 - 169, 04.03.2021

Ahmet Tutuncu Erhan Yılmaz

https://doi.org/10.18621/eurj.775245

Cited By: 1

Abstract

Objectives: In patients who do not respond to medical treatment with idiopathic premature ventricular complex (PVC), catheter ablation is performed using the electroanatomic mapping (3D EAM) system for ablation. The aim of this study is to evaluate the acute and long-term success of patients and the procedural features and complication results associated with PVC localization in patients who underwent catheter ablation in our center.

Methods: Two hundred seventeen patients who underwent activation mapping and ablation using 3D EAM for PVC were included in the study. Patients were followed up for acute procedure success, periprocedural complications, and six-month long-term recurrence. In addition, these parameters, PVC’s were evaluated in three groups as right ventricular outflow tract (RVOT), coronary cusp and rare localized origin, and clinical outcomes and interventional variables related to the success of the PVC’s location were compared.

Results: In our study, the mean age of the patients was 43 ± 12.1 years and the female gender ratio was 37.8%. When catheter ablated PVC foci were evaluated, it is seen that 81 (37.3%) were from RVOT and 56 (25.8%) were from coronary cusp. In addition, 6 (2.8%) were aortomitral continuity, 22 (10.1%) were left ventricular summit/epicardial, 17 (7.8%) were parahisian, and total 80 (36.8%) were rare localized PVCs. Acute procedure success was 92.6% and long-term procedure success was 83% in all cases. When the patients in our study were analyzed according to their PVC locations and procedure successes, those with rare localization compared to those with RVOT and coronary cusp origin were 66 (87.5%), 79 (96.3%), and 53 (94.6%); respectively (p = 0.03) and long-term successes were 58 (72.5%), 73 (90.1%), and 49 (87.5%); respectively (p < 0.05). Long-term transaction success was lower.

Conclusions: Frequent PVCs can be treated with electroanatomic mapping and radiofrequency ablation with high success rate and low complication rate. Patients with RVOT and coronary cusp-derived PVC had a high acute and long-term success rate, while success rates were lower in rare localized PVCs from epicardial/summit, papillary muscle, parahisian and tricuspid-mitral anulus.

Keywords

premature ventricular complexes, catheter ablation, electroanatomic mapping

References

• 1. Ruberman W, Weinblatt E, Goldberg JD, Frank CW, Shapiro S. Ventricular premature beats and mortality after myocardial infarction. N Eng J Med 1977;297:750-7.
• 2. DeMaria AN, Amsterdam EA, Vismara LA, Neumann A, Mason DT. Arrhythmias in the mitral valve prolapsed syndrome. Prevalence, nature and frequency. Ann Intern Med 1976;84:656-60.
• 3. Savage DD, Seides SF, Maron BJ, Myers MJ, Epstein SE. Prevalence of arrhythmias during 24 hour electrocardiographic monitoring and exercise testing in patients with obstructive and nonobstructive hypertrophic cardiomyopathy. Circulation 1979;59:866-75.
• 4. Bikkina M, Larson MG, Levy D. Asymptomatic ventricular arrhythmias and mortality risk in subjects with left ventricular hypertrophy. J Am Coll Cardiol 1993;22:1111-16.
• 5. Kostis JB, McCrone K, Moreyra AE, Gotzoyannis S, Aglitz NM, Natarajan N, et al. Premature ventricular complexes in the absence of identifiable heart disease. Circulation 1981;63:1351-6.
• 6. Hasdemir C, Ulucan C, Yavuzgil O, Yuksel A, Kartal Y, Simsek E, et al. Tachycardia-induced cardiomyopathy in patients with idiopathic ventricular arrhythmias: the incidence, clinical and electrophysiologic characteristics, and the predictors. J Cardiovasc Electrophysiol 2011;22:663-8.
• 7. Taieb JM, Maury P, Shah D, Duparc A, Galinier M, Delay M, et al. Reversal of dilated cardiomyopathy by the elimination of frequent left or right premature ventricular contractions. J Interv Card Electrophysiol 2007;20:9-13.
• 8. Latchamsetty R, Bogun F. Premature ventricular complex induced cardiomyopathy. Rev Esp Cardiol (Engl Ed) 2016;69:365-9.
• 9. Singh SN, Fletcher RD, Fisher SG, Singh BN, Lewis HD, Deedwania PC, et al. Amiodarone in patients with congestive heart failure and asymptomatic ventricular arrhythmia. Survival trial of antiarrhythmic therapy in congestive heart failure. N Engl J Med 1995;333:77-82.
• 10. Peichl P, Wichterle D, Pavlu L, Cihak R, Aldhoon B, Kautzner J. Complications of catheter ablation of ventricular tachycardia: a single-center experience. Circ Arrhythm Electrophysiol 2014;7:684-90.
• 11. Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, et al. Heart disease and stroke statistics -- 2014 update: a report from the American Heart Association. Circulation 2014;129: e28-e292.
• 12. Aliot EM, Stevenson WG, Almendral-Garrote JM, Bogun F, Calkins CH, Delacretaz E, et al. EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias: developed in a partnership with the European Heart Rhythm Association (EHRA), a Registered Branch of the European Society of Cardiology (ESC), and the Heart Rhythm Society (HRS); in collaboration with the American College of Cardiology (ACC) and the American Heart Association (AHA). Heart Rhythm 2009;6:886-933.
• 13. Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M, et al. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death). J Am Coll Cardiol 2006;48:e247-e346.
• 14. Latchamsetty R, Yokokawa M, Morady F, Kim HM, Mathew S, Tilz R, et al. Multicenter outcomes for catheter ablation of idiopathic premature ventricular complexes. JACC Clin Electrophysiol 2015;1:116-23.
• 15. Nakagawa M, Takahashi N, Nobe S, Ichinose M, Ooie T, Yufu F, et al. Gender differences in various types of idiopathic ventricular tachycardia. J Cardiovasc Electrophysiol 2002;13:633-8.
• 16. Spesific Arrhythmias: Diagnosis and Treatment in Braunwald’s Heart Disease A textbook of cardiovascular medicine. 10th Ed.. Philadelphia 2015: p.771-3.
• 17. Stec S, Sikorska A, Zaborska B, Krynski T, Szymot J, Kulakowski P. Benign symptomatic premature ventricular complexes: short-and long-term efficacy of antiarrhythmic drugs and radiofrequency ablation. Kardiol Pol 2012;70:351-8.
• 18. Krittayaphong R, Bhuripanyo K, Punlee K, Kangkagate C, Chaithiraphan S. Effect of atenolol on symptomatic ventricular arrhythmia without structural heart disease: a randomized placebo-controlled study. Am Heart J 2002;144:e10.
• 19. Echt DS, Liebson PR, Mitchell LB, Peters RW, Obias-Manno D, Barker AH, et al. Mortality and morbidity in patients receiving encainide, flecainide, or placebo. The cardiac arrhythmia suppression trial. N Engl J Med 1991;324:781-8.
• 20. Ling Z, Liu Z, Su L, Zipunnikov V, Wu J, Du H, et al. Radiofrequency ablation versus antiarrhythmic medication for treatment of ventricular premature beats from the right ventricular outflow tract: prospective randomized study. Circ Arrhythm Electrophysiol 2014;7:237-43.
• 21. Zhong L, Lee YH, Huang XM, Asirvatham SJ, Shen WK, Friedman PA, et al. Relative efficacy of catheter ablation vs antiarrhythmic drugs in treating premature ventricular contractions: a single-center retrospective study. Heart Rhythm 2014;11:187-93.
• 22. Wang Y, Eltit JM, Kaszala K, Tan A, Jiang M, Zhang M, et al. Cellular mechanism of premature ventricular contraction-induced cardiomyopathy. Heart Rhythm 2014;11:2064-72.
• 23. Mountantonakis SE, Frankel DS, Gerstenfeld EP, Dixit S, Lin D, Hutchinson MD, et al. Reversal of outflow tract ventricular premature depolarization-induced cardiomyopathy with ablation: effect of residual arrhythmia burden and preexisting cardiomyopathy on outcome. Heart Rhythm 2011;8:1608-14.
• 24. Ban JE, Park HC, Park JS, Nagamoto Y, Choi JI, Lim HE, et al. Electrocardiographic and electrophysiological characteristics of premature ventricular complexes associated with left ventricular dysfunction in patients without structural heart disease. Europace 2013;15:735-41.
• 25. Baman TS, Lange DC, Ilg KJ, Gupta SK, Liu TY, Alguire C, et al. Relationship between burden of premature ventricular complexes and left ventricular function. Heart Rhythm 2010;7:865-9.
• 26. Kanei Y, Friedman M, Ogawa N, Hanon S, Lam P, Schweitzer P. Frequent premature ventricular complexes originating from the right ventricular outflow. Ann Noninvasive Electrocardiol 2008;13:81-5.
• 27. Sheldon SH, Gard JJ, Asirvatham SJ. Premature ventricular contractions and non-sustained ventricular tachycardia: association with sudden cardiac death, risk stratification, and management strategies. Indian Pacing Electrophysiol J 2010;10:357-71.
• 28. Duffee DF, Shen WK, Smith HC. Suppression of frequent premature ventricular contractions and improvement of left ventricular function in patients with presumed idiopathic dilated cardiomyopathy. Mayo Clin Proc 1998;73:430-3.
• 29. Sohn DW, Chai IH, Lee DJ, Kim HC, Kim HS, Oh BH, et al. Assesment of mitral annulus velocity by Doppler tissue imaging in the evalution left ventricular diastolic function. J Am Coll Cardiol 1997;30:474-80.
• 30. Stevenson WG. Current treatment of ventricular arrhythmias: state of the art. Heart Rhythm 2013;10:1919-26.
• 31. Lee A, Denman R, Haqqani HM. Ventricular ectopy in the context of left ventricular systolic dysfunction: risk factors and outcomes following catheter ablation. Heart Lung Circ 2019;28:379-88.
• 32. 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 2007;4:7-16.
• 33. Wang JS, Shen YG, Yin RP, Thapa S, Peng YP, Ji KT, et al. The safety of catheter ablation for premature ventricular contractions in patients without structural heart disease. BMC Cardiovasc Disord 2018;18:177.
• 34. Baman TS, Ilg KJ, Gupta SK, Good E, Chugh A, Jongnarangsin, et al. Mapping and ablation of epicardial idiopathic ventricular arrhythmias from within the coronary venous system. Circ Arrhythm Electrophysiol 2010;3: 274-9.
• 35. Yokokawa M, Latchamsetty R, Good E, Chugh A, Pelosi F, Jr, Crawford T, et al. Ablation of epicardial ventricular arrhythmias from nonepicardial sites. Heart Rhythm 2011;8:1525-9.
• 36. Carrigan T, Patel S, Yokokawa M, Swanson S, Morady F, Bogun F. Anatomic relationships between the coronary venous system, surrounding structures, and the site of origin of epicardial ventricular arrhythmias. J Cardiovasc Electrophysiol 2014;25:1336-42.
• 37. Yokokawa M, Good E, Desjardins B, Crawford T, Jongnarangsin K, Chugh A, et al. Predictors of successful catheter ablation of ventricular arrhythmias arising from the papillary muscles. Heart Rhythm 2010;7:1654-9.
• 38. Good E, Desjardins B, Jongnarangsin K, Oral H, Chugh A, Ebinger M, et al. Ventricular arrhythmias originating from a papil- lary muscle in patients without prior infarction: a comparison with fascicular arrhythmias. Heart Rhythm 2008;5:1530-7.
• 39. Peichl P, Wichterle D, Pavlu L, Cihak R, Aldhoon B, Kautzner J. Complications of catheter ablation of ventricular tachycardia: a single-center experience. Circ Arrhythm Electrophysiol 2014;7:684-90.
• 40. Capucci A, DiPasquale G, Boriani G, Carini G, Balducelli M, Frabetti L, et al. A double-blind cross over comparison of flecainide and slow-release mexiletine in thetreatment of stable premature ventricular complexes. Int J Clin Pharmacol Res 1991;11:23-33.