Long term effectiveness of catheter ablation in patients with frequent premature ventricular complexes

Abstract Background Premature ventricular complexes (PVCs) constitute a commonly encountered arrhythmia. Catheter ablation has emerged as a safe and effective therapeutic modality. However, long term follow-up data are still lacking. Purpose We conducted long term follow-up of patients who underwent catheter ablation for frequent PVCs, defined as more than 10.000, during at least two 24- hour ambulatory ECG- monitoring. Methods This retrospective cohort study included 152 patients (34.2% female; median age 58.4, IQR 24.1 years) who underwent catheter ablation at a single center from 2015 to 2022. PVC burden ranged from 10 to 30% in 113 patients (74.34%) and over 30% in 39 patients (25.6%). We sought to evaluate the following factors: Patient demographics, procedural characteristics and outcomes, complication rates and long-term clinical outcomes. There were 37 (24.3%) patients with already diagnosed structural heart disease (27 with ischemic heart disease, 7 with dilated cardiomyopathy, 1 with valvular heart failure, 1 with hypertensive heart failure and 1 with non- dilated left ventricular cardiomyopathy). A diagnosis of PVC induced cardiomyopathy, prior to ablation, was established in 21 (13.8) % of cases. Prior to catheter ablation, 142 patients had received beta-blockers and 22 had received class IC or III antiarrhythmics, without PVCs suppression. Results Acute procedural success was achieved in 139 (91.4 %) of patients. In the long term follow up of the successful cases (mean follow up 3.6 ± 2.3 years), 6 recurrences were observed (among them, a new origin of PVCs was noted in one patient, 4 years after the index procedure). Patients with PVCs originating from sites other than the outflow tracts were more likely to experience arrhythmia recurrence (log- rank test, p = 0.029). PVC induced cardiomyopathy resolved in 18 out of 21 patients, post catheter ablation. Among the failed cases, one procedure was discontinued due to intraprocedural tamponade. The rest of the failed cases were attributed to inaccessible site of origin, mainly left ventricular summit (n= 4) and papillary muscle (n = 5). No procedure-related mortality was recorded. Cardiac tamponade occurred interprocedurally in two patients (1.32%) and was successfully treated with pericardiocentesis. Both were attributed to the use of non- contact force technology. Temporal conduction system disturbances (less than 24 hours duration) were noted in 6 patients (3.9%). One patient suffered intraprocedural ischemic stroke, which was successfully treated with thrombectomy. One patient suffered vascular access-related complication, namely femoral hematoma, which required vascular surgery. Mean procedural duration was 134.7 ± 48 minutes. Conclusion In the long term follow up, catheter ablation of frequent PVCs demonstrates safety and effectiveness, and requires multidisciplinary approach of complications management.Long Term follow-up