Effects of Catheter Ablation of “Asymptomatic” Frequent Ventricular Premature Complexes in Patients With Reduced (<48%) Left Ventricular Ejection Fraction




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.



Table 1

Baseline patient clinical characteristics, ventricular premature complex (VPC) burden and left ventricular ejection fraction (LVEF) before and after ablation





































































































































































































































































































































































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

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Dec 7, 2016 | Posted by in CARDIOLOGY | Comments Off on Effects of Catheter Ablation of “Asymptomatic” Frequent Ventricular Premature Complexes in Patients With Reduced (<48%) Left Ventricular Ejection Fraction

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