Impact of radiofrequency ablation of frequent post-infarction premature ventricular complexes on left ventricular ejection fraction.
BACKGROUND
Frequent idiopathic premature ventricular complexes (PVC) are associated with a reversible form of cardiomyopathy. The effect of frequent PVCs on left ventricular function has not been evaluated in post-infarction patients.


OBJECTIVE
This study sought to evaluate the value of post-infarction PVC ablation and possible determinants of a reversible cardiomyopathy.


METHODS
Thirty consecutive patients (24 men, age 61 +/- 12, left ventricular ejection fraction [LVEF] 0.36 +/- 0.12) with remote myocardial infarction referred for implantable cardioverter-defibrillator (ICD) implantation for primary prevention of sudden death or for management of symptomatic ventricular tachycardia or PVCs were evaluated. Fifteen patients with a high PVC burden (>or=5% of all QRS complexes on 24-h Holter monitor) underwent mapping and ablation of PVCs before ICD implantation. The remaining 15 patients served as a control group. LVEF was assessed by echocardiography, and scar burden was assessed by cardiac magnetic resonance imaging with delayed enhancement (DE-MRI) in both groups.


RESULTS
PVC ablation was successful in 15 of 15 patients and reduced the mean PVC burden from 22 +/- 12% to 2.6 +/- 5.0% (P <.001). After the procedure, LVEF increased significantly from 0.38 +/- 0.11 to 0.51 +/- 0.09 in the PVC ablation group (P = .0001). In the control group, LVEF remained unchanged within the same time frame (0.34 +/- 0.14 vs. 0.33 +/- 0.15; P = .6). Patients with frequent PVCs had a significantly smaller scar burden by DE-MRI compared with control patients. Five of the patients with frequent PVCs underwent ICD implantation.


CONCLUSIONS
Post-infarction patients with frequent PVCs may have a reversible form of cardiomyopathy. DE-MRI may identify patients in whom the LVEF may improve after ablation of frequent PVCs.
Sarrazin
Jean-Francois
JF
Department of Cardiology, University of Michigan Health System, Ann Arbor, Michigan, USA.
Labounty
Troy
T
Kuhne
Michael
M
Crawford
Thomas
T
Armstrong
William F
WF
Desjardins
Benoit
B
Good
Eric
E
Jongnarangsin
Krit
K
Chugh
Aman
A
Oral
Hakan
H
Pelosi
Frank
F
Morady
Fred
F
Bogun
Frank
F
D000368:Aged; D017115:Catheter Ablation; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications*; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology; D018879:Ventricular Premature Complexes / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*