Predictors of recovery of left ventricular dysfunction after ablation of frequent ventricular premature depolarizations.
BACKGROUND
Frequent ventricular premature depolarizations (VPDs) can cause reversible left ventricular (LV) dysfunction. However, not all patients normalize their LV function after VPD elimination.


OBJECTIVE
To evaluate predictors of recovery of LV function following the elimination of frequent VPDs.


METHODS
We identified patients with ≥10% VPDs/24 h and an LV ejection fraction of <50% who underwent successful ablation between 2007 and 2011. Subjects were classified as having reversible (≥10% increase to a final LV ejection fraction of ≥50%) or irreversible (≤10% increase or final LV ejection fraction <50%) LV dysfunction on the basis of echocardiographic follow-up. A reference group with ≥10% VPDs but normal LV function was identified.


RESULTS
One hundred fourteen patients with ≥10% VPDs were identified; 66 had preserved and 48 had impaired LV function. Over a median follow-up of 10.6 months, 24 of 48 were classified as reversible and 13 of 48 as irreversible and 11 of 44 were excluded. There was a gradient of VPD QRS duration between the control, reversible, and irreversible groups (mean VPD QRS 135, 158, and 173 ms, respectively; P < .001). This gradient persisted even for the same site of origin. In multivariate analysis, the only independent predictor of irreversible LV function was VPD QRS duration (odds ratio 5.07 [95% confidence interval 1.22-21.01] per 10-ms increase).


CONCLUSIONS
In patients with LV dysfunction and frequent VPDs, we identified VPD QRS duration as the only independent predictor for the recovery of LV function after ablation. This suggests that VPD QRS duration may be a marker for the severity of underlying substrate abnormality.
Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
Marc W
MW
Deyell
Kyoung-Min
KM
Park
Yuchi
Y
Han
David S
DS
Frankel
Sanjay
S
Dixit
Joshua M
JM
Cooper
Mathew D
MD
Hutchinson
David
D
Lin
Fermin
F
Garcia
Rupa
R
Bala
Michael P
MP
Riley
Edward
E
Gerstenfeld
David J
DJ
Callans
Francis E
FE
Marchlinski
D000959:Antihypertensive Agents / Q000627:therapeutic use; D017115:Catheter Ablation; D004232:Diuretics / Q000627:therapeutic use; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011184:Postoperative Period; D011379:Prognosis; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D016277:Ventricular Function, Left; D018879:Ventricular Premature Complexes / Q000150:complications / Q000473:pathology / Q000628:therapy*
D000959:Antihypertensive Agents; D004232:Diuretics