ClinicalAblationClinical significance of myocardial scar in patients with frequent premature ventricular complexes undergoing catheter ablation
Introduction
Frequent premature ventricular complexes (PVCs) can cause a reversible form of cardiomyopathy.1 PVC-induced cardiomyopathy (PICM) has been described in patients with and those without structural heart disease.2 In up to 25% of patients without apparent heart disease, scarring has been detected by cardiac magnetic resonance imaging (CMR).3 Whether the presence of scarring impacts on the development of PICM and whether scarring impacts on the procedural outcomes of PVC ablation and postablation recovery of left ventricular (LV) dysfunction are unclear. The purpose of this study was to assess the impact of focal scarring on PICM and the outcomes of catheter ablation of frequent PVCs.
Section snippets
Patient characteristics
The study consisted of 351 consecutive patients (170 women [48%]; age 53 ± 15 years; ejection fraction [EF] 51% ± 12%) with frequent PVCs who were referred for catheter ablation (Table 1). Patients had failed to respond to a mean of 1.24 ± 0.9 antiarrhythmic medications. All patients underwent CMR with late gadolinium enhancement for assessment of myocardial scarring. Seventy-seven patients had known heart disease before the appearance of frequent PVCs, including 38 with ischemic cardiomyopathy
CMR findings
A total of 134 of 351 patients (38%) had scarring on CMR. Patients with scarring more frequently had PICM (66/134 [49%]) compared to patients without scarring (54/217 [25%]; P <.001). Scar volume in patients with PICM was greater than in patients without PICM (total scar: 0.31 [0–1.33] cm3 vs 0 [0–0.46] cm3; P = .01).
In patients with scarring, there was no significant difference in scar size between patients without improvement of the EF postablation compared to scar size in patients in whom EF
Main findings
The presence of focal myocardial scarring is independently associated with PICM. Despite lower procedural success rates in patients with scar, significant improvement in EF could be seen after ablation in most of these patients.
Scar and cardiomyopathy
To the best of our knowledge, this study is the first to report on DE-CMR–defined focal cardiac scar as a factor associated with PICM. This finding has important clinical implications because advanced cardiac imaging is not routinely performed in patients with frequent
Conclusion
Most patients with frequent PVCs and PICM have focal scarring by CMR. The presence of focal myocardial scarring is independently associated with PICM. Although the presence of scar is associated with lower ablation success rates and lower postablation EF, successful ablation in these patients still can result in substantial recovery of EF. Longitudinal studies in patients with PVCs may help to further clarify temporal relationships and causality between scarring and PICM.
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Cited by (7)
Factors predictive for delayed enhancement in cardiac resonance imaging in patients undergoing catheter ablation of premature ventricular complexes
2021, Heart Rhythm O2Citation Excerpt :Other prospective studies have similarly reported that cardiac scar confers a risk of sudden death even among patients with normal or only mildly decreased EF.16 The presence of cardiac scar is independently associated with the development of PVC-induced cardiomyopathy.17 Accordingly, patients in this study with cardiac scar had greater net increase in EF compared to those without scar.
Strain Analysis in Patients with Frequent Premature Ventricular Complexes and Preserved Left Ventricular Function Undergoing Ablation
2023, Journal of Clinical MedicineFrequent premature ventricular complexes are benign!?
2023, EuropaceMechanisms and Risk Factors for Premature Ventricular Contraction Induced Cardiomyopathy
2023, Reviews in Cardiovascular MedicineEpicardial mapping and ablation of ventricular tachycardia in patients after coronary artery bypass surgery: don’t forget the coronary venous system!
2023, Journal of Interventional Cardiac ElectrophysiologyIntramural mapping of intramural septal ventricular arrhythmias
2022, Journal of Cardiovascular Electrophysiology
Funding sources: This research was supported by funding from the French National Research Agency (ANR) under Grant Agreements Equipex MUSIC ANR-11-EQPX-0030 and IHU LIRYC ANR-10-IAHU-04; and from the European Research Council under Grant Agreement ERC No. 715093.
Disclosures: The authors have no conflicts of interest to disclose.