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Reversal of left ventricular dysfunction after ablation of premature ventricular contractions related parameters, paradoxes and exceptions to the rule

2016; Elsevier BV; Volume: 222; Linguagem: Inglês

10.1016/j.ijcard.2016.07.005

1874-1754

Marie Sadron Blaye-Felice, David Hamon, Frédéric Sacher, Patrizio Pascale, Anne Rollin, Vanina Bongard, Alexandre Duparc, Pierre Mondoly, Nicolas Derval, Arnaud Denis, Christelle Cardin, Mélèze Hocini, Pierre Jaı̈s, Étienne Pruvot, Jürg Schlaepfer, Didier Carrié, Michel Galinier, Nicolas Lellouche, Michel Haı̈ssaguerre, Philippe Maury,

Cardiac electrophysiology and arrhythmias

Background Suppression of frequent premature ventricular contractions (PVCs) does not systematically lead to an expected reversal of PVC-induced cardiomyopathy and determinants of left ventricular ejection fraction (LVEF) recovery (reverse remodeling) after ablation remain largely unknown. Methods Ninety-six consecutive patients with a suspicion of PVC induced-cardiomyopathy were retrospectively included. Parameters potentially related to reverse remodeling (>10% increase in LVEF) were analyzed in patients w/wo long-term success (decrease in PVC burden >80%). Results Over a mean follow-up of 24 ± 21 months, long-term ablation success was obtained in 76 patients (79%). In these, reverse remodeling was observed in 63 (83%) (LVEF 39 ± 8 to 56 ± 8%, p < 0.0001). In multivariate analysis, only an older age (and marginally a lower PVC QRS amplitude) was independently associated with the lack of reverse remodeling. Only 10 of the 35 patients who initially should have received an ICD for primary prevention remained candidates for implantation after ablation. Lack of reverse remodeling was significantly linked to a higher mortality. Conclusion Reverse remodeling was observed in 83% of patients with frequent PVC and unexplained cardiomyopathy undergoing long-term successful ablation of the PVC. A younger age was independently correlated with the occurrence of reverse remodeling.