Radiofrequency Catheter Ablation of Premature Ventricular Contractions
from the Mitral Annulus in Patients without Structural Heart Disease
Abstract
INTRODUCTION: We previously reported the clinical benefits of
radiofrequency catheter ablation (RFCA) of premature ventricular
contractions (PVCs) from the right ventricular outflow tract or near
His-bundle, which often can deteriorate clinical status and cause left
ventricular (LV) dilation that develops into heart failure. This study
aimed to evaluate the role of ablating PVCs per RFCA from a
trans-interatrial septal approach in the LV dilation and clinical status
in patients with PVCs from the mitral annulus (MA) (MA-PVCs) without
structural heart disease. METHODS: The frequency of PVCs per the total
heart beats by 24-h Holter monitoring, left ventricular ejection
fraction (LVEF) and left ventricular end-diastolic (LVDd) and -systolic
(LVDs) internal dimensions by echocardiography, New York Heart
Association (NYHA) functional class, and serum brain natriuretic peptide
(BNP) concentration in 22 patients with MA-PVCs were evaluated before
and 6 months after RFCA. RESULTS: Before the RFCA, the patients with
frequent (20% <) PVCs demonstrated a significantly reduced
LVEF, enlarged LVDd and LVDs, deteriorated NYHA functional class, and
elevated serum BNP concentration as compared to the subgroup with rare
(≤ 20%) PVCs. Furthermore, ablating MA-PVCs readily produced an
improvement in those abnormalities as compared to that before the RFCA.
Interestingly, the MA-PVCs were successfully ablated from not only the
ventricular side of the MA (68%) or coronary sinus (5%), but also the
left atrial side of the MA (18%). CONCLUSIONS: RFCA produces clinical
benefits in patients with MA-PVCs. Further, it may be necessary to
initially consider a trans-interatrial septal approach to ablate these
PVCs.