Radiofrequency Catheter Ablation for the Treatment of Idiopathic Premature Ventricular Contractions Originating From the Right Ventricular Outflow Tract

A Systematic Review and Meta-analysis

Jasmine Lamba, B.SC., M.D; Damian P. Redfearn, M.B. CH.B; Kevin A. Michael, M.B. CH.B; Christopher S. Simpson, M.D; Hoshiar Abdollah, M.B. CH.B; Adrian Baranchuk, M.D.

Disclosures

Pacing Clin Electrophysiol. 2014;37(1):73-78. 

In This Article

Abstract and Introduction

Abstract

Background Frequent idiopathic premature ventricular contractions (PVCs) have been associated with left ventricular cardiomyopathy. Idiopathic PVCs often originate from the right ventricular outflow tract (RVOT), and radiofrequency catheter ablation (RFCA) is being used as a treatment to alleviate symptoms. A meta-analysis was performed to evaluate RFCA for the treatment of frequent idiopathic PVCs on heart function.

Methods and Results A literature search was conducted using Medline and Embase to identify studies evaluating the effects of RFCA as treatment for PVCs originating from the RVOT. Articles were chosen if they reported the effect of RFCA on the quantity of PVCs or ventricular function. Only studies in English were included. Articles were excluded if they did not separate results for PVCs originating from areas other than the RVOT. A total of 450 articles were retrieved from electronic searches, and 14 articles were included in this systematic review. Six of these were meta-analyzed (N = 70) and showed a reduction in the total number of PVCs in 24 hours after RFCA by a mean of –30089.44 confidence interval [CI]: –31658.47, –28520.40, P < 0.00001). Left ventricular ejection fraction (LVEF) was reported in five of the 14 studies, which included 108 patients. RFCA significantly improved LVEF by a mean of 10.36 (CI: 8.75, 11.97, P < 0.00001) in patients with frequent PVCs from the RVOT. The remaining studies reported their results differently and were not included in the meta-analyses but were described separately.

Conclusions RFCA reduces the number of PVCs and improves the cardiac function in patients with idiopathic frequent PVCs originating from the RVOT.

Introduction

Idiopathic premature ventricular contractions (PVCs) originate largely from the right ventricular outflow tract (RVOT) and can be quite symptomatic for some patients. Recent evidence has shown that patients with highly frequent RVOT ectopy can develop cardiomyopathy with reduced left ventricular systolic function.[1–3] Radiofrequency catheter ablation (RFCA) has been used in patients with refractory arrhythmia despite treatment with antiarrhythmic and/or β-blockers agents that continue to be highly symptomatic or for the prevention of ventricular dysfunction.[4,5]

The aim of this study was to conduct a systematic review and meta-analysis of patients referred to RFCA due to PVCs originating from the RVOT.

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