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Effectiveness of catheter ablation for treatment of symptomatic frequent premature ventricular complexes
Session:
Posters (Sessão 4 - Écran 4) - Taquicardia ventricular e morte súbita cardíaca
Speaker:
Ricardo Carvalheiro
Congress:
CPC 2023
Topic:
C. Arrhythmias and Device Therapy
Theme:
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
Subtheme:
08.7 Ventricular Arrhythmias and SCD - Other
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Ricardo Carvalheiro; Paulo Medeiros; Bárbara Teixeira; Miguel Antunes; Ana Lousinha; Pedro Silva Cunha; Bruno Valente; Guilherme Portugal; Madalena Cruz; Cátia Guerra; Ana S. Delgado; Rui Cruz Ferreira; Mário Oliveira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif">Introduction: The most recent ESC guidelines recommend catheter ablation (CA) as the first-line treatment for symptomatic premature ventricular complexes (PVC) originating from the right ventricle outflow tract (RVOT) or the left fascicles, and state that CA may be considered for the treatment of PVC of any other origin. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif">Purpose: To study the impact of PVC ablation on the total PVC number, PVC burden and left ventricle ejection fraction (LVEF), comparing outcomes in groups with and without structural heart disease (SHD). </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif">Methods: Single-center retrospective cohort of adults subjected to PVC ablation between January 2020 and March 2022.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif">Results: 51 patients (P) (62.7% male, mean age 51±16 years) underwent CA. There was SHD in 19P (37,3%): tachycardia-induced cardiomyopathy – 9P, non-ischemic dilated cardiomyopathy – 9P, congenital heart disease – 1P. The mean LVEF before CA was 59% (IQR 49-60), and the median number of PVCs was 15707 (IQR 11846-22465), with a mean PVC burden of 18.9±11.6%. Of those that undertook cardiac magnetic resonance imaging (31P, 60.8%), 16.1% had late enhancement. Electroanatomical activation maps were obtained using CARTO (51%) and the ENSITE systems (49%). In 20% of the cases, pacemapping was also used. The main PVC origin location was the RVOT (23P, 45.1%). The mean procedure duration was 122±51 min, with an acute success of 81%. Complications occurred in 4P (7.8%) – the main one being vascular access injury (2P, 3.9%). </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif">After a median follow-up 379 days (IQR 157-525), beta-blockers were used in 33.4% of P, class IC antiarrhythmics in 6.3% and class III antiarrythmics in 6.3%. The median PVC number at follow-up was 513 (IQR 27-15000), PVC burden 0,5% (IQR 0,03-10) and EF 60% (IQR 55-60); a Wilcoxon signed-rank test showed PVC ablation elicited a statistically significant decrease in PVC number (Z = -4,445, p<0.001), in PVC burden (Z = - 4,474, p<0.001), and an increase in EF (Z = -2,038, p=0.042). <s>A</s>nalysis of subgroups showed a significant difference in PVC number at follow-up in the group without SHD (Z = -4,457, p<0,001), but not in the group with SHD (Z= -1,647, p=0,099).</span></span></p> <p><span style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif">Conclusion: After catheter ablation, there was a statistically significant reduction in PVC number and burden, and an increase in EF. The presence of SHD was associated with worst outcomes in this population.</span></span></p>
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