Introduction: Retrospective studies have demonstrated catheter ablation can reduce premature ventricular complex (PVC) burden. However, the association between objective and patient reported outcomes is unclear, with reporting on the latter particularly limited. The aim of this study was to measure and correlate objective and subjective outcomes of patients undergoing PVC ablation for symptomatic benefit.
Methods: This was a retrospective, observational single centre study. Acute procedural success was operator reported and defined as the elimination of the targeted PVC(s) at the termination of the procedure at least 30 minutes after the last ablation. Objective success was the absence, or greater than 50% reduction, of PVC burden on ≥24 hours Holter monitoring at follow-up compared to baseline. Subjective success was defined by the patient as the reported absence, or significant reduction, of their PVC-associated symptoms at follow-up. Logistic regression analysis was performed to identify association.
Results: 125 PVC ablation procedures were performed between November 2016 and July 2019 at our institution. The mean age was 52.5±15.7 and 67 (53%) patients were male. Symptom relief was the primary indication in 104 (83%). 66 (53%) had a structurally normal heart on echo or MRI with an average LV ejection fraction of 41±12% amongst those with structural heart disease. Acute procedural success was reported in 81 (65%) cases. No significant association was seen between the procedural success reported by the operator and subjective improvement in symptoms at follow-up. 48 (38%) patients had objective and subjective follow-up. Subjective success was reported by 39 (81%). Symptomatic improvement was associated with a greater reduction in PVC burden than in those who had unchanged or worse symptoms. (-88% [-100%- -60%] vs -76%, [-84%- -0%] p=0.045). Patients with symptomatic improvement also had a lower absolute PVC burden at follow-up (2.6%, [0%- 8%] vs 5%, [4%- 22%] p=0.041). The ability to discriminate positive vs negative symptomatic outcomes based on absolute PVC burden at follow-up was moderate (AUC=0.80).
Conclusions: Objective benefit after PVC ablation in our study is in line with published International registry outcomes. Subjective success was common, but patients should be aware that procedural success may not be indicative of final outcome. Objective evaluation of PVC burden may be of value in discriminating symptom origin but further study is required to better delineate any correlation. Although the study design may be vulnerable to confounder bias, the results support prospective, blinded study to provide evidence-based decision-making and consent as well as expectation management.