Frequent ventricular premature complexes (VPCs), particularly those without troublesome palpitations, are often regarded as a benign arrhythmia and are not treated other than with reassurance. However, VPCs can contribute to left ventricular (LV) dysfunction in the absence of symptoms. The present study was designed to investigate whether catheter ablation of VPCs can improve LV dysfunction in patients with and without troublesome palpitations. Of 80 consecutive patients who underwent catheter ablation of frequent VPCs, 24 (aged 60 ± 15 years) were found to have a reduced LV ejection fraction at baseline (<48%) and included in the present study. No important procedure-related complications occurred in these patients. During a median follow-up of 8 months, the VPC burden after ablation had decreased from 15 ± 6% to 1 ± 1% (p <0.001), and the left ventricular ejection fraction had increased from 32 ± 15% to 43 ± 14% (p <0.001). Ten patients (42%) had no palpitations before ablation. In the other 14 patients, the palpitations were improved or entirely resolved after ablation. No significant difference was found in the extent of LV ejection fraction improvement after ablation between patients with and without palpitations (+11 ± 12% vs +11 ± 11%, p = 0.941) or between patients with different locations of VPC origin. In conclusion, VPCs might not necessarily be associated with palpitations in many patients with LV dysfunction. Successful ablation of frequent VPCs in these “asymptomatic” patients is associated with an improvement in LV function similar to that observed in “symptomatic” patients.
Catheter ablation of ventricular premature complexes (VPCs) is usually driven by the desire to provide symptom relief. Because VPCs generally produce a less efficient left ventricular (LV) contraction than does a sinus beat, it can be reasonably expected that elimination of frequent VPCs could lead to improved LV function in patients with reduced LV function. However, it is unclear whether the hemodynamic beneficial effects of the elimination of VPCs by catheter ablation can also be achieved in those without troublesome palpitations. The present study was designed to investigate whether ablation of frequent VPCs can achieve similar beneficial effects on LV function in patients with and without palpitations.
Methods
A total of 80 consecutive patients who underwent catheter ablation of frequent VPCs were screened for the present study. Of these 80 patients, 24 (30%) had reduced LV function. These 24 patients were included in the present study for additional analysis. Their mean age was 60 ± 15 years, and their mean LV ejection fraction (LVEF) was 32 ± 15%. The clinical characteristics of these patients are listed in Table 1 . The institutional review committee of the University of Minnesota (study no. 1110M05461) approved the study.
Pt No. | Palpitations | Age (y) | Gender | Heart Disease | AADs | VPC Morphology | VPC Axis | VPC Origin | LVEF (%) | VPC (%) | ||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Baseline | Follow-Up | Baseline | Follow-Up | |||||||||
1 | No | 36 | Female | CAD | M, A | LBBB | Inferior | RVOT | 45 | 50 | 19.0 | 0.7 |
2 | No | 42 | Male | No | M | LBBB | Inferior | RVOT | 38 | 55 | 28.0 | 2.0 |
3 | No | 51 | Female | IDC | M | RBBB | Superior | LVB | 10 | 15 | 9.5 | 0.2 |
4 | No | 52 | Female | IDC | M | RBBB | Superior | LVB | 40 | 40 | 13.7 | 1.0 |
5 | No | 57 | Male | HTN, CAD | M | RBBB | Inferior | LVOT | 15 | 35 | 14.5 | 1.0 |
6 | No | 66 | Male | HTN, IDC | M | LBBB | Inferior | LVB | 30 | 45 | 19.0 | 1.5 |
7 | No | 71 | Female | HTN, CAD | M, S/A | RBBB | Superior | LVB | 18 | 50 | 14.0 | 0.5 |
8 | No | 75 | Male | CAD | M, A | LBBB | Inferior | LVB | 42 | 38 | 8.0 | 0.5 |
9 | No | 76 | Male | HTN, CAD | No | LBBB | Inferior | RVOT | 15 | 20 | 21.0 | 0.5 |
10 | No | 84 | Female | HTN | No | LBBB | Superior | LVB | 40 | 55 | 18.0 | 1.5 |
11 | Yes | 26 | Male | No | M, A | LBBB | Inferior | LVOT | 47 | 55 | 17.3 | 0.5 |
12 | Yes | 38 | Male | HTN | No | RBBB | Superior | LVB | 45 | 60 | 14.0 | 1.0 |
13 | Yes | 51 | Male | HTN, CAD | No | RBBB | Inferior | LVB | 45 | 45 | 10.0 | 0.2 |
14 | Yes | 51 | Female | HTN, IDC | No | LBBB | Superior | RVB | 45 | 55 | 12.8 | 2.5 |
15 | Yes | 57 | Female | HTN, IDC | S | RBBB | Inferior | LVB | 45 | 35 | 25.0 | 1.8 |
16 | Yes | 58 | Female | HTN, IDC | 0 | LBBB | Inferior | RVOT | 15 | 60 | 11.5 | 2.0 |
17 | Yes | 59 | Male | HTN, IDC | A | RBBB | Superior | LVB | 45 | 60 | 18.0 | 2.8 |
18 | Yes | 60 | Male | HTN, IDC | A | LBBB | Inferior | RVOT | 15 | 35 | 21.0 | 2.0 |
19 | Yes | 63 | Male | No | M | RBBB | Superior | LVB | 47 | 55 | 7.0 | 4.5 |
20 | Yes | 64 | Female | IDC | No | RBBB | Inferior | LVOT | 25 | 35 | 9.2 | 2.5 |
21 | Yes | 65 | Male | CAD | M, A | LBBB | Inferior | LVOT | 40 | 50 | 18.0 | 0.5 |
22 | Yes | 67 | Male | HTN, CAD | No | RBBB | Inferior | LVB | 15 | 28 | 14.4 | 0.9 |
23 | Yes | 77 | Male | HTN, CAD | M, A | LBBB | Inferior | RVOT | 5 | 15 | 5.9 | 0.7 |
24 | Yes | 87 | Female | No | No | LBBB | Inferior | LVOT | 45 | 50 | 7.8 | 1.0 |