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CLINICAL RESEARCH: HEART RHYTHM DISORDERS

Radiofrequency catheter ablation of premature ventricular complexes from right ventricular outflow tract improves left ventricular dilation and clinical status in patients without structural heart disease

Internal Medicine, Kyushu Kosei-Nenkin Hospital, Kitakyushu, Japan.

Manuscript received October 9, 2004; revised manuscript received December 2, 2004, accepted December 6, 2004.

^_* Reprint requests and correspondence: Dr. Masao Takemoto, Internal Medicine, Kyushu Kosei-Nenkin Hospital, 1-8-1 Kishinoura, Yahatanishi-ku, Kitakyushu 806-8501, Japan. (Email: matakemo{at}aol.com).

OBJECTIVES: The present study evaluated clinical benefits of radiofrequency catheter ablation (RFA) for premature ventricular complexes from right ventricular outflow tract (RVOT-PVC) in patients without structural heart disease.

BACKGROUND: It is unknown whether PVC causes left ventricular (LV) dilation, which is a well-recognized precursor of LV dysfunction and heart failure, and whether eliminating PVC by RFA produces clinical benefits in patients with RVOT-PVC.

METHODS: Frequency of PVC per total heart beats by 24-h Holter monitoring, left ventricular ejection fraction (LVEF), left ventricular end-diastolic internal dimension (LVDd), mitral regurgitation (MR) by echocardiogram, cardiothoracic ratio (CTR) by chest radiogram, and New York Heart Association (NYHA) functional class of 40 patients with RVOT-PVC without structural heart disease were evaluated before and 6 to 12 months after RFA.

RESULTS: Before RFA, a subgroup of patients with frequent (>20%) PVC demonstrated significantly enlarged LVDd and CTR, reduced LVEF, increased MR, and deteriorated NYHA functional class as compared to the subgroup with rare (<20%) PVC (54 ± 1 mm vs. 45 ± 1 mm, 52 ± 2% vs. 46 ± 1%, 66 ± 2% vs. 73 ± 2%, 1.2 ± 0.2 degree vs. 0.4 ± 0.1 degree, and 1.8 ± 0.2 vs. 1.3 ± 0.1, respectively; p < 0.05). Furthermore, ablating RVOT-PVC readily produced the improvement of all these abnormalities (47 ± 1 mm, 41 ± 1%, 72 ± 2%, 0.3 ± 0.1 degree, and 1.0 ± 0.0, respectively; p < 0.05 compared with before RFA).

CONCLUSIONS: These findings suggest that frequent (>20%) RVOT-PVC may be a possible cause of LV dysfunction and/or heart failure, and RFA produces clinical benefits in these patients.

Abbreviations and Acronyms   LBBB = left bundle branch block   LV = left ventricle/ventricular   LVDd = left ventricular end-diastolic internal dimension   LVDs = left ventricular end-systolic internal dimension   LVEF = left ventricular ejection fraction   NYHA = New York Heart Association   PVC = premature ventricular complexes   RFA = radiofrequency catheter ablation   RV = right ventricle/ventricular   RVOT = right ventricular outflow tract   %PVC = frequency of premature ventricular complexes

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