What is the role of catheter ablation in the treatment of premature ventricular contractions (PVCs)?

Updated: Jan 13, 2017
  • Author: James E Keany, MD, FACEP; Chief Editor: Erik D Schraga, MD  more...
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Catheter ablative therapy has a role in the management of patients with PVCs. [13, 14] This is in the setting of PVCs from the right or left ventricular outflow tract that occur in structurally normal hearts. Ablation is indicated for frequent, symptomatic PVCs that occur despite medical therapy. Success is variable, depending on frequency and inducibility at the time of electrophysiologic study (EPS).

Guidelines on the use of catheter ablation in ventricular arrhythmia are available from the European Heart Rhythm Association (EHRA) and the Heart Rhythm Society (HRS) in collaboration with the American College of Cardiology (ACC) and the American Heart Association (AHA). [15]

Fichtner et al evaluated the outcome and success of PVC ablation in 408 patients in the German Ablation Registry from March 2007 to May 2011. [16] The acute ablation success rate was 82%; all patients were discharged alive after a median of 3 days; and no patient suffered an acute MI, stroke, or major bleeding. After 12 months of follow-up, 99% of patients were still alive, and 76% showed significantly improved symptoms.

Im et al investigated ECG criteria for predicting successful ablation of PVCs from the right coronary cusp (RCC). They found that the presence of a dominant positive lead I, an R-wave duration index (RWDI) higher than 43.6%, and an S-wave amplitude lower than 0.95mV in aVL predicted RCC PVCs in patients with a sensitivity of 83% and a specificity of 94%. [17]

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