Impact of radiofrequency ablation of frequent post-infarction premature ventricular complexes on left ventricular ejection fraction

BackgroundFrequent idiopathic premature ventricular complexes (PVC) are associated with a reversible form of cardiomyopathy. The effect of frequent PVCs on left ventricular function has not been evaluated in post-infarction patients.ObjectiveThis study sought to evaluate the value of post-infarction PVC ablation and possible determinants of a reversible cardiomyopathy.MethodsThirty consecutive patients (24 men, age 61 ± 12, left ventricular ejection fraction [LVEF] 0.36 ± 0.12) with remote myocardial infarction referred for implantable cardioverter-defibrillator (ICD) implantation for primary prevention of sudden death or for management of symptomatic ventricular tachycardia or PVCs were evaluated. Fifteen patients with a high PVC burden (≥5% of all QRS complexes on 24-h Holter monitor) underwent mapping and ablation of PVCs before ICD implantation. The remaining 15 patients served as a control group. LVEF was assessed by echocardiography, and scar burden was assessed by cardiac magnetic resonance imaging with delayed enhancement (DE-MRI) in both groups.ResultsPVC ablation was successful in 15 of 15 patients and reduced the mean PVC burden from 22 ± 12% to 2.6 ± 5.0% (P <.001). After the procedure, LVEF increased significantly from 0.38 ± 0.11 to 0.51 ± 0.09 in the PVC ablation group (P = .0001). In the control group, LVEF remained unchanged within the same time frame (0.34 ± 0.14 vs. 0.33 ± 0.15; P = .6). Patients with frequent PVCs had a significantly smaller scar burden by DE-MRI compared with control patients. Five of the patients with frequent PVCs underwent ICD implantation.ConclusionPost-infarction patients with frequent PVCs may have a reversible form of cardiomyopathy. DE-MRI may identify patients in whom the LVEF may improve after ablation of frequent PVCs.