Beneficial effects of catheter ablation on left ventricular and right ventricular function in patients with frequent premature ventricular contractions and preserved ejection fraction.
BACKGROUND
Improvement of left ventricular ejection fraction (LVEF) after radiofrequency catheter ablation (RFCA) of frequent premature ventricular contractions (PVCs) has been reported. However, most patients with frequent PVCs have a normal LVEF. In these patients subtle and early forms of PVC-induced left and right ventricular (RV) impairment may not be detected by standard echocardiographic techniques.


OBJECTIVE
To assess the effect of frequent PVCs on ventricular function in patients with preserved LVEF.


METHODS
49 patients (30 male, 49+/-16 years) with recent-onset (median 1.2 years), frequent PVCs (burden 26+/-13%) and 25 healthy controls were studied. Thirty-four patients with PVCs underwent successful RFCA. Two-dimensional echocardiography was performed at baseline and follow-up. LV volumes and LVEF were calculated by Simpson's rule. Tricuspid annulus plane systolic excursion and fractional area change were calculated to assess RV function. Multidirectional LV strain (radial, circumferential, longitudinal) and RV free-wall longitudinal strain were calculated by two-dimensional speckle tracking imaging. At baseline LVEF, volumes and RV dimensions were normal in patients and controls.


RESULTS
Speckle tracking imaging demonstrated reduced LV and RV strain in patients with PVC as compared with controls. At follow-up there were no changes in LVEF, LV volumes and RV dimensions and function in patients successfully treated by RFCA and untreated patients. However, radial, circumferential and longitudinal strain improved significantly in patients after RFCA but remained unchanged in untreated patients.


CONCLUSIONS
Frequent PVCs can induce subtle cardiac dysfunction detected by speckle tracking imaging analysis in patients without apparent cardiomyopathy. RFCA can successfully eliminate PVCs and improve cardiac function.
Wijnmaalen
Adrianus P
AP
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Delgado
Victoria
V
Schalij
Martin J
MJ
van Huls van Taxis
Carine F B
CF
Holman
Eduard R
ER
Bax
Jeroen J
JJ
Zeppenfeld
Katja
K
D000328:Adult; D000368:Aged; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D008297:Male; D008875:Middle Aged; D013318:Stroke Volume / Q000502:physiology; D016896:Treatment Outcome; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000209:etiology*; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging / Q000209:etiology*; D018879:Ventricular Premature Complexes / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*