Influence of myocardial scar on the response to frequent premature ventricular complex ablation

Heart. 2019 Mar;105(5):378-383. doi: 10.1136/heartjnl-2018-313452. Epub 2018 Sep 21.

Abstract

Objective: This study aims to evaluate the influence of myocardial scar after premature ventricular complexes (PVC) ablation in patients with left ventricular (LV) dysfunction.

Methods: 70 consecutive patients (58±11 years, 58 (83%) men, 23% (18-32) mean PVC burden) with LV dysfunction and frequent PVCs submitted for ablation were included. A late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) was performed prior to the ablation and a quantitative and qualitative analysis of the scar was done.

Results: Left ventricular ejection fraction progressively improved from 34.3%±9% at baseline to 44.4%±12% at 12 months (p<0.01) and 48 (69%) patients were echocardiographic responders. New York Heart Association class improved from 1.96±0.9 points at baseline to 1.36±0.6 at 12 months (p<0.001). Brain natriuretic peptide decreased from 120 (60-284) to 46 (23-81) pg/mL (p=0.04). Twenty-nine (41%) patients showed scar in the preprocedural LGE-CMR with a mean scar mass of 10.4 (5-20) g. Mean scar mass was significantly smaller in responders than in non-responders (0 (0-4.7) g vs 2 (0-14) g, respectively, p=0.017). PVC burden reduction (OR 1.09 (1.01-1.16), p=0.02) and scar mass (OR 0.9 (0.81-0.99), p=0.04) were independent predictors of response, but the former showed a higher accuracy.

Conclusions: Presence of myocardial scar modulates, but does not preclude, the probability of response to PVC ablation in patients with LV dysfunction.

Keywords: ablation; cardiac magnetic resonance; left ventricular dysfunction; myocardial scar; premature ventricular complex.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Catheter Ablation* / adverse effects
  • Catheter Ablation* / methods
  • Cicatrix / pathology*
  • Echocardiography / methods
  • Female
  • Humans
  • Image Enhancement
  • Magnetic Resonance Imaging, Cine / methods*
  • Male
  • Middle Aged
  • Myocardium / pathology
  • Natriuretic Peptide, Brain / blood
  • Outcome and Process Assessment, Health Care
  • Prognosis
  • Reproducibility of Results
  • Stroke Volume
  • Ventricular Dysfunction, Left* / diagnosis
  • Ventricular Dysfunction, Left* / physiopathology
  • Ventricular Premature Complexes* / diagnosis
  • Ventricular Premature Complexes* / pathology
  • Ventricular Premature Complexes* / surgery

Substances

  • Natriuretic Peptide, Brain