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Arrhythmias and sudden death
Original research article
Influence of myocardial scar on the response to frequent premature ventricular complex ablation
  1. Diego Penela1,
  2. Mikel Martínez2,
  3. Juan Fernández-Armenta3,
  4. Luis Aguinaga4,
  5. Luis Tercedor5,
  6. Augusto Ordóñez6,
  7. Juan Acosta7,
  8. Julio Martí-Almor8,
  9. Felipe Bisbal9,10,
  10. Luca Rossi1,
  11. Roger Borràs2,
  12. Markus Linhart2,
  13. David Soto-Iglesias2,
  14. Beatriz Jáuregui2,
  15. José T Ortiz-Pérez2,
  16. Rosario J Perea2,
  17. Xavier Bosch2,
  18. Lluis Mont2,10,
  19. Antonio Berruezo11
  1. 1 Ospedale Guglielmo da Saliceto, Piacenza, Italy
  2. 2 Hospital Clínic, Universitat de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
  3. 3 Hospital Puerta del Mar, Cadiz, Spain
  4. 4 Private Cardiology Center, Tucumán, Argentina
  5. 5 Hospital Virgen de las Nieves, Granada, Spain
  6. 6 Hospital Sant Pau i Santa Tecla, Tarragona, Spain
  7. 7 Hospital Universitario Virgen del Rocío, Sevilla, Spain
  8. 8 Hospital del Mar, Barcelona, Spain
  9. 9 Institut del Cor (iCor), Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
  10. 10 Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
  11. 11 Centro Médico Teknon, Barcelona, Spain
  1. Correspondence to Dr Antonio Berruezo, Heart Institute, Teknon Medical Center, Barcelona 08022, Spain; berruezo{at}clinic.ub.es

Abstract

Objective This study aims to evaluate the influence of myocardial scar after premature ventricular complexes (PVC) ablation in patients with left ventricular (LV) dysfunction.

Methods 70 consecutive patients (58±11 years, 58 (83%) men, 23% (18–32) mean PVC burden) with LV dysfunction and frequent PVCs submitted for ablation were included. A late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) was performed prior to the ablation and a quantitative and qualitative analysis of the scar was done.

Results Left ventricular ejection fraction progressively improved from 34.3%±9% at baseline to 44.4%±12% at 12 months (p<0.01) and 48 (69%) patients were echocardiographic responders. New York Heart Association class improved from 1.96±0.9 points at baseline to 1.36±0.6 at 12 months (p<0.001). Brain natriuretic peptide decreased from 120 (60–284) to 46 (23–81) pg/mL (p=0.04). Twenty-nine (41%) patients showed scar in the preprocedural LGE-CMR with a mean scar mass of 10.4 (5–20) g. Mean scar mass was significantly smaller in responders than in non-responders (0 (0–4.7) g vs 2 (0–14) g, respectively, p=0.017). PVC burden reduction (OR 1.09 (1.01–1.16), p=0.02) and scar mass (OR 0.9 (0.81–0.99), p=0.04) were independent predictors of response, but the former showed a higher accuracy.

Conclusions Presence of myocardial scar modulates, but does not preclude, the probability of response to PVC ablation in patients with LV dysfunction.

  • premature ventricular complex
  • ablation
  • left ventricular dysfunction
  • myocardial scar
  • cardiac magnetic resonance

https://doi.org/10.1136/heartjnl-2018-313452

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    Footnotes

    • DP and MM contributed equally.

    • Contributors DP, MM and AB wrote the manuscript. DP, JF-A, LM and AB planned the study. RB performed the statistical analysis. LA, LT, AO, JA, JM-A, FB, LR, ML, DS-I, BJ, JTO-P, RJP and XB collected data. AB is responsible for the overall content as guarantor.

    • Funding This work was supported by Instituto de Salud Carlos III (Madrid, Spain) through the project “PI14/00759” (Co-funded by European Regional Development Fund/European Social Fund "Investing in your future").

    • Competing interests None declared.

    • Patient consent Obtained.

    • Ethics approval The present observational study complies with the Declaration of Helsinki and was approved by the local regulatory authorities.

    • Provenance and peer review Not commissioned; externally peer reviewed.