Radiofrequency Catheter Ablation of Premature Ventricular Beats Among Egyptians: Predictors of Success and Recurrence

Abstract

SUMMARY P remature ventricular beats are a common occurrence within the general population and frequently observed during routine clinical examination. Patients with PVBs may present with debilitating symptoms such as palpitations, chest pain, presyncope, syncope, and heart failure. Traditionally, they have been thought to be relatively benign in the absence of structural heart disease. Over the last decade, PVBs-induced cardiomyopathy became a subject of great interest and the evidence for this entity is rapidly emerging. Several published studies showed that the frequency of PVBs correlates with the extent of LV dysfunction and ventricular dilation at the time of initial clinical presentation. Patients with decreased LVEF had a higher mean PVB burden than their counterparts with normal LV function. Suppression of PVBs using either anti-arrhythmic pharmacological agents or radiofrequency catheter ablation techniques appears to reverse the LV dysfunction. Radiofrequency catheter ablation has become an effective curative procedure for the treatment of symptomatic idiopathic premature ventricular contractions. This study was conducted at Cardiology department, Ain Shams University Hospitals from October 2013 to October 2015. In the present study, radio-frequency catheter ablation procedure for idiopathic monomorphic PVBs was performed in 40 patients. Studied population was divided into two groups (20 patients in each) according to the presence or absence of structural heart disease, all patients underwent electrophysiological study and ablation and their clinical, electrophysiological and procedural data were recorded and analyzed. The studied population had a mean age of 39.95 yrs, 57.5% of patients were males, and the mean duration of symptoms was 5.8 years, all patients included in this study were symptomatic and the most frequent complaint was palpitations followed by SOB. PVB origin was initially identified using 12 lead surfaces ECG, and then intra-cardiac localization was done during mapping, revealing RVOT origin in 17 patients, LVOT and aortic sinuses in 19 patients and non outflow origin in 3 patients. 3D electro-anatomical mapping modalities were used in 22 patients. Acute success was defined as disappearance of clinical PVBs or sporadic PVBs less than one per minute by the end of the procedure, and was achieved in 35patients (87.5%), Follow up Holter ECG monitoring and trans thoracic echocardiography was done 3-6 months post-procedural to assess recurrence of PVBs.