Site-dependent outcomes in Premature Ventricular Contraction (PVC) ablation: insights from a cohort study

Background

Premature ventricular contractions (PVCs) are common, and patients who develop symptoms or PVC-induced cardiomyopathy have an indication for arrhythmia suppression with medication or ablation.

Purpose

We aimed to assess the procedural and clinical outcomes of idiopathic PVC ablation across different sites of origin. Our outcomes of interest at 1 year follow-up were as follows:

1. PVC burden reduction, defined as >80% reduction or post-ablation burden <5% in cases with significant pre-procedural PVCs.

2. Left ventricular ejection fraction (LVEF) improvement, defined as 5% increase or post-ablation LVEF > 50%.

Methods

We retrospectively reviewed all PVC ablation cases at our center between August 2019 and March 2025, identifying 202 cases. After excluding 10 cases with missing data and 25 cases where ablation was not performed (limited PVC inducibility, n=21; intra-procedural risks, n=4), 167 cases were analyzed: RVOT (n=63), LVOT (n=65), and Other (n=39). Other ablation sites included papillary muscle (n=9), parahisian (n=9), basal/septal wall (n=8), and other locations (n=13). Data collected included patient demographics, pre/post ablation antiarrhythmic therapy, cardiac function, and PVC burden. Logistic regression was used to assess outcomes based on PVC origin while controlling for potential confounders, including BMI, pre-operative EF and antiarrhythmic therapy.

Results

Mean follow-up was 1.4 ± 0.8 years. The average age was 56.5 ± 14.9 years, with 89 males (53.3%). Pre-ablation, 133 patients (80%) were on class II or IV antiarrhythmic drugs, and 39 (23%) were on class I or III therapies. Overall success rates were 66.5% for PVC burden reduction and 74.2% for LVEF improvement. RVOT ablations had higher burden reduction compared to LVOT (81% vs. 63%, p=0.04) and other sites (81% vs. 49%, p=0.001). Four complications (2.4%) occurred in the study population: two LVOT and two non-outflow tract. Scar on CMR was present in 23.3% of patients. Those without scar had higher success rates in burden reduction (70.9% vs. 51.3%, p=0.04) and LVEF improvement (82.7% vs. 48.7%, p<0.001). 21 patients underwent repeat ablation. Success rates were similar between patients undergoing repeat ablation and those receiving a single procedure, both for PVC burden reduction (71.4% vs. 70.7%, p=1) and LVEF improvement (66.7% vs. 78.9%, p=0.34). Logistic regression demonstrated RVOT ablation to have 2.3-fold higher odds of burden reduction compared to LVOT or non-outflow tract ablations.

Conclusions

In this single-center retrospective study, RVOT ablations were associated with higher success rates and fewer complications compared to LVOT and non-outflow sites. Inferior outcomes at non-RVOT sites highlight the importance of optimizing medical therapy before considering ablation in these patients.