Premature Ventricular Complex Ablation in Structural Heart Disease

摘要

The significance of premature ventricular complexes (PVCs) in the setting of structural heart disease, particularly in patients with a history of myocardial infarction, has long been studied. Early analyses suggested a worse prognosis in patients with a recent myocardial infarction with frequent PVCs, multiform PVCs, or nonsustained ventricular tachycardia (VT). Initial attempts to eliminate or reduce this ventricular ectopy, however, was met with disappointing results and the use of anti-arrhythmic drugs (AADs) resulted in an increase in mortality. The conclusion was that the presence of PVCs in this setting represented a worse prognosis but was not an underlying, and moreover, a modifiable cause. More recently, frequent PVCs have been verified to cause a decrease in left ventricular ejection fraction as well as chamber dilatation. Furthermore, elimination of these PVCs with successful catheter ablation can abate and usually reverse this process. Although the majority of data focus on patients with idiopathic PVCs, there are also data verifying the ability of PVCs to worsen preexisting cardiomyopathy and the ability of successful ablation to provide an improvement in cardiac function in patients with underlying structural heart disease.