Elsevier

Heart Rhythm

Volume 11, Issue 2, February 2014, Pages 187-193
Heart Rhythm

Relative efficacy of catheter ablation vs antiarrhythmic drugs in treating premature ventricular contractions: A single-center retrospective study

https://doi.org/10.1016/j.hrthm.2013.10.033Get rights and content

Background

It is unknown whether radiofrequency ablation (RFA) or antiarrhythmic therapy is superior when treating patients with symptomatic premature ventricular contractions (PVCs).

Objective

To determine the relative efficacy of RFA and antiarrhythmic drugs (AADs) on PVC burden reduction and increasing left ventricular systolic function.

Methods

Patients with frequent PVCs (>1000/24 h) were treated either by RFA or with AADs from January 2005 through December 2010. Data from 24-hour Holter monitoring and echocardiography before and 6–12 months after treatment were compared between the 2 groups.

Results

Of 510 patients identified, 215 (40%) underwent RFA and 295 (60%) received AADs. The reduction in PVC frequency was greater by RFA than with AADs (–21,799/24 h vs –8,376/24 h; P < .001). The left ventricular ejection fraction (LVEF) was increased significantly after RFA (53%–56%; P < .001) but not after AAD (52%– 52%; P = .6) therapy. Of 121 (24%) patients with reduced LVEF, 39 (32%) had LVEF normalization to 50% or greater. LVEF was restored in 25 of 53 (47%) patients in the RFA group compared with 14 of 68 (21%) patients in the AAD group (P = .003). PVC coupling interval less than 450 ms, less impaired left ventricular function, and RFA were independent predictors of LVEF normalization performed by using multivariate analysis.

Conclusion

RFA appears to be more effective than AADs in PVC reduction and LVEF normalization.

Introduction

Classically, premature ventricular contractions (PVCs) have been considered relatively benign in the absence of structural heart disease. However, frequent PVCs may result in left ventricular (LV) systolic dysfunction, a form of PVC-induced cardiomyopathy (PVC-CMP) or PVC-mediated deterioration of preexisting cardiomyopathy.1 Factors that may lead to the development of PVC-CMP include PVC burden and duration, QRS width, and site of origin. Antiarrhythmic drug (AAD) suppression or catheter-based radiofrequency ablation (RFA) of frequent PVCs may restore ventricular function in the absence of known heart disease, supporting the concept of PVC-CMP.2, 3 For decades, AADs, including class I or III AADs, β-blockers, or a nondihydropyridine calcium channel blocker (CCB), have been considered first-line therapy to suppress PVCs. RFA has emerged as an effective alternative to the pharmacologic approach for many forms of supraventricular or ventricular arrhythmia.4, 5, 6, 7 Whether medical therapy or RFA is superior is relatively unknown. The present study sought to compare the efficacy of RFA and AADs on PVC burden and LV systolic function in clinical practice and to evaluate the factors associated with the risk of developing PVC-CMP.

Section snippets

Study patients

This retrospective study was approved by the Mayo Clinic Institutional Review Board, and all patients included had consented to the use of their data for research purposes. The eligible study cohort was identified by using the Rochester Medical Index database of Mayo Clinic. The Rochester Medical Index classified 5183 patients’ diagnoses of PVC between January 2005 and December 2010 by using an internal coding system based on the Hospital Adaptation of the International Classification of

Baseline characteristics

Five hundred ten patients with frequent PVCs were included in the study (mean age 55 ± 18 years; 56% men) after excluding 1193 patients with PVC >1000/24 h but not meeting the eligible criteria (Figure 1). Of these, 215 (40%) underwent RFA and 295 (60%) were treated with AADs. The RFA group was younger than the AAD group (47 ± 16 years vs 62 ± 18 years; P < .001) and less often had coronary heart disease (6% vs 13%; P = .01) and hypertension (11% vs 36%; P < .001) (Table 1). The PVC frequency

Main findings

Numerous published articles have shown convincing evidence that catheter-based RFA is an effective therapy to eliminate PVCs.5, 6, 7, 8, 9, 10, 11, 12 However, medical therapy remains the mainstay of treatment of this condition.1, 3, 13, 14 Whether there is a definitive difference in the outcome with these 2 therapies remains unknown. The present study represents the current management of frequent PVCs in routine practice in a single center and provides a few new findings. First, compared with

Conclusions and implications

Frequent PVCs may be the consequence of LV systolic dysfunction or the cause of DCM. It is a current concept that reduction of frequent PVCs with AADs or by RFA may improve LV function in patients presenting with newly recognized depressed LV function and frequent PVCs. Catheter ablation appears to be more effective than AADs in PVC frequency reduction and LVEF normalization. A randomized controlled clinical trial is needed to provide comparative outcomes between these 2 therapies.

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