What is the role of ablation therapy in the treatment of ventricular premature complexes (VPCs)?

Updated: Nov 26, 2016
  • Author: Jatin Dave, MD, MPH; Chief Editor: Jose M Dizon, MD  more...
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Answer

The 2006 ACC/AHA/ESC guideline recommends that ablation therapy should be considered in the following [18] :

  • Patients with frequent, symptomatic, and monomorphic VPCs refractory to medical therapy

  • Patients who choose to avoid long-term medical therapy

  • Patients with ventricular arrhythmia storm that is consistently provoked by VPBs of a similar morphology

VPCs arising from the outflow tract (OT) are the most common subtype of idiopathic VPCs; more than 70-80% of premature ventricular contractions (PVCs) originate from the right ventricular (RV) OT. The remaining VPCs originate from other sites (left and right coronary cusp, mitral annulus, and on the epicardium near the left ventricular [LV] OT). Highly symptomatic and refractory cases of VPCs especially from RVOT are appropriate for ablation therapy, with success rates over 70%.

The selection of an endocardial versus an epicardial approach to target ventricular arrythmia depends on the patient’s underlying disease substrate, as well as the location of the arrhythmogenic substrate within the myocardial wall, which can be best assessed with a cardiac MRI. [23]


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