title: Ablation of frequent PVC in patients meeting criteria for primary prevention ICD implant: Safety of withholding the implant.
abstract: BACKGROUND
  Premature ventricular complex (PVC) ablation has been shown to improve left ventricular ejection fraction (LVEF) and New York Heart Association functional class in patients with left ventricular dysfunction. Both are considered key variables in predicting risk of sudden cardiac death.
  
  
  OBJECTIVE
  The objective of this study was to assess whether ablation might remove the primary prevention (PP) implantable cardioverter-defibrillator (ICD) indication in patients with frequent PVC.
  
  
  METHODS
  Sixty-six consecutive patients with PP-ICD indication and frequent PVC [33 (50%) men; mean age 53 ± 13 years; 11 (17%) with ischemic heart disease] underwent PVC ablation. The ICD was withheld and the indication was reevaluated at 6 and 12 months.
  
  
  RESULTS
  LVEF progressively improved from 28% ± 4% at baseline to 42% ± 12% at 12 months (P < .001). New York Heart Association functional class improved from 2 patients with NYHA functional class I (3%) at baseline to 35 (53%) at 12 months (P < .001). The brain natriuretic peptide level decreased from 246 ± 187 to 176 ± 380 pg/mL (P = .004). The PP-ICD indication was removed in 42 patients (64%) during follow-up, from 38 (92%) of them at 6 months, showing an independent association with baseline PVC burden and successful sustained ablation. In patients with successful sustained ablation, a cutoff value of 13% PVC burden had a sensitivity of 100% and a specificity of 93% (area under the curve 99%) for removing ICD indication postablation. No sudden cardiac deaths or malignant ventricular arrhythmias were observed.
  
  
  CONCLUSIONS
  In patients with frequent PVC and PP-ICD indication, ablation improves LVEF and, in most cases, allows removal of the indication. Withholding the ICD and reevaluating within 6 months of ablation seems to be a safe and appropriate strategy.
authors.affiliation: Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Catalonia, Spain.
authors.forename: Diego
authors.initials: D
authors.lastname: Penela
authors.affiliation: Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Catalonia, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Acosta
authors.affiliation: Private Cardiology Center, Tucuman, Argentina.
authors.forename: Luis
authors.initials: L
authors.lastname: Aguinaga
authors.affiliation: Cardiology Department, Hospital Virgen de las Nieves, Granada, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Tercedor
authors.affiliation: Cardiology Department, Hospital Sant Pau i Santa Tecla, Tarragona, Catalonia, Spain.
authors.forename: Augusto
authors.initials: A
authors.lastname: Ordoñez
authors.affiliation: Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Catalonia, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Fernández-Armenta
authors.affiliation: Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Catalonia, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Andreu
authors.affiliation: Cardiology Department, Hospital Virgen de las Nieves, Granada, Spain.
authors.forename: Pablo J
authors.initials: PJ
authors.lastname: Sánchez-Millán
authors.forename: Pablo
authors.initials: P
authors.lastname: Sánchez
authors.affiliation: Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Catalonia, Spain.
authors.forename: Nuno
authors.initials: N
authors.lastname: Cabanelas
authors.affiliation: Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Catalonia, Spain.
authors.forename: Jose Maria
authors.initials: JM
authors.lastname: Tolosana
authors.affiliation: Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Catalonia, Spain.
authors.forename: Francesca
authors.initials: F
authors.lastname: Vassanelli
authors.affiliation: Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Catalonia, Spain.
authors.forename: Mario
authors.initials: M
authors.lastname: Cabrera
authors.affiliation: Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Catalonia, Spain.
authors.forename: Viatcheslav
authors.initials: V
authors.lastname: Korshunov
authors.affiliation: Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Catalonia, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Sitges
authors.affiliation: Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Catalonia, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Brugada
authors.affiliation: Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Catalonia, Spain.
authors.forename: Lluis
authors.initials: L
authors.lastname: Mont
authors.affiliation: Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Catalonia, Spain. Electronic address: berruezo@clinic.ub.es.
authors.forename: Antonio
authors.initials: A
authors.lastname: Berruezo
mesh_terms: D000328:Adult; D000368:Aged; D017115:Catheter Ablation; D017147:Defibrillators, Implantable; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011322:Primary Prevention; D011446:Prospective Studies; D013318:Stroke Volume; D016896:Treatment Outcome; D018879:Ventricular Premature Complexes / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control / Q000628:therapy*; D028761:Withholding Treatment
keywords: Ablation; Implantable cardioverter-defibrillator; Premature ventricular complex; Primary prevention; Sudden cardiac death