B-po05-125 the potential of advanced techniques for premature ventricular contraction ablation

The utility of advanced techniques (investigational needle ablation, epicardial, and simultaneous two site unipolar radiofrequency ablation) for ablation of premature ventricular contractions (PVCs) is not clear. To evaluate the patient characteristics and PVC origins in patients who failed standard endocardial ablation for PVCs and assess the potential efficacy of advanced techniques. We retrospectively reviewed 290 procedures in 281 consecutive patients who underwent PVC ablation. In patients who failed endocardial standard ablation, we considered performing an advanced ablation technique. Acute success was defined as abolition of the target PVC. Of 281 patients, standard RF ablation was acutely successful in 80%. Failure was not predicted by PVC site, history of prior ablation, or underlying heart disease (table). Of the 49 procedures that failed standard ablation, advanced techniques were performed in 30 and were successful in 23 of 30 (76%; 8% of the total population). Needle ablation, epicardial and simultaneous two site unipolar RF ablation were performed in 17, 9, and 4 procedures, respectively. Advanced technique ablation patients were more likely to have had prior ablation procedures (90% vs 26%; P < 0.01) and nonischemic cardiomyopathy (60% vs 30%; P < 0.05) and 60% had LVOT PVCs. Complications, often related to vascular access, were not different for advanced techniques and the standard RF group (7% vs 2%). Standard ablation is acutely successful in 80% of patients. Advanced techniques increased acute success to 88% with acceptable risk and were most commonly used in the LVOT.