title: Benign symptomatic premature ventricular complexes: short- and long-term efficacy of antiarrhythmic drugs and radiofrequency ablation.
abstract: BACKGROUND
  There is little data on the long-term efficacy of antiarrhythmic drugs (AADs) and radiofrequency catheter ablation (RFCA) in patients with symptomatic premature ventricular complexes (PVCs) and no organic heart disease.
  
  
  OBJECTIVE
  To evaluate the short- and long-term efficacy and tolerance of AAD therapy and RFCA in patients with idiopathic PVCs.
  
  
  METHODS
  This was a prospective, crossover, open-label study performed in 84 consecutive patients (mean age 47 ± 15 years; 60% women) with symptomatic idiopathic PVCs (mean PVCs/24 h, 13,768 ± 9,424; range 1,693-42,687). Patients were treated for 2-3 weeks with metoprolol, propafenone or verapamil. Then patients were referred for RFCA, if they had drug intolerance, inefficacy or did not wish to have prolonged AAD treatment.
  
  
  RESULTS
  The most efficacious agent was propafenone, followed by verapamil, and then metoprolol [35 (42%), 13 (15%) and eight (10%) responders, respectively, p < 0.01 vs propafenone]. Only responders to drug treatment had a significant reduction in symptom severity (Visual Analogue Scale score: 6.2 ± 1.4 vs 2.7 ± 2.0, p < 0.001). After AAD, 50 (60%) patients underwent RFCA. During long-term follow-up (48 ± 10 months), RFCA (mean 1.2 procedures/patient) was effective in 44/50 (88%) patients. Of the 34 remaining patients, 21 remained on effective AAD, 6 patients remained on ineffective AAD, and 7 patients were taken off AADs therapy due to spontaneous remission of PVCs or a decrease in symptom severity. conclusions: Short-term treatment with propafenone was more effective than verapamil or metoprolol in suppressing idiopathic PVCs. However, optimal benefit was achieved with RFCA, which was effective and safe during long-term follow-up.
authors.affiliation: Department of Cardiology, Postgraduate Medical School, Grochowski Hospital, Warsaw, Poland. smstec@wp.pl
authors.forename: Sebastian
authors.initials: S
authors.lastname: Stec
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Sikorska
authors.forename: Beata
authors.initials: B
authors.lastname: Zaborska
authors.forename: Tomasz
authors.initials: T
authors.lastname: Kryński
authors.forename: Joanna
authors.initials: J
authors.lastname: Szymot
authors.forename: Piotr
authors.initials: P
authors.lastname: Kułakowski
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D017115:Catheter Ablation / Q000379:methods*; D018592:Cross-Over Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008790:Metoprolol / Q000627:therapeutic use*; D008875:Middle Aged; D011405:Propafenone / Q000627:therapeutic use*; D011446:Prospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D018879:Ventricular Premature Complexes / Q000628:therapy*; D014700:Verapamil / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D000889:Anti-Arrhythmia Agents; D011405:Propafenone; D014700:Verapamil; D008790:Metoprolol