Effects Of Radiofrequency Catheter Ablation Of Premature Ventricular Complexes On Patients With Normal Left Ventricular Function

BACKGROUND : Frequent premature ventricular complexes(PVC)can lead to left ventricular dysfunction,as PVC induced cardiomyopathy.Successful radiofrequency catheter ablation(RFCA)can improve this situation.However,the effect of radiofrequency catheter ablation on left ventricular function is still not clearinpatients with normal left ventricular systolic function.Meanwhile,guidelineshave not recommended RFCA to patients without symptoms or without taking of anti-arrhythmia drugs.OBJECTIVE:To study the effect of RFCAof PVC on the left ventricular function in patients with normal left ventricular systolic function and the value of RFCA onpatients without symptoms and without taking of anti-arrhythmia drugs.METHODS:Select the frequent PVC patients who hospitalize and accept radiofrequency catheter ablation in Department of Cardiology,Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine from 2010 to 2014.The number of PVCs in 24 hour ambulatory electrocardiogram(ECG)should ?5000.The left ventricular ejection fraction(EF)of preoperative echocardiography should ?50%.Collect the clinicaldata,preoperative echocardiography,preoperative 24 hour ambulatoryECG,origin site of PVCs,etc.Echocardiography and 24 hour ambulatory ECG datas were followed up from 3,6,12 to 24 months after operation.RESULTS:453 patients were selected,31 were in preoperative 50%?EF<60% group and 422 were in EF?60% group.There were no significant differences in gender,age,duration of symptoms,clinical symptoms,past history,complications,and drug use history between the two groups.The number of PVCs in the 24 hour ambulatory ECG was significantly more in 50%?EF<60% group than EF?60% group.The LVEDD,LVESD were larger while EF was lower in PVC?20000 group than 5000?PVC<10000 and 10000?PVC<20000 groups.The origin site of PVCs had no difference.178 patients were followed up after operation.Recurrence of PVCs after operation occurred in 21 patients and 157 did not.Postoperative LVEDD,LVESD and EF were not significantly different with that before operation in patients with PVC recurrence,while in patients without recurrence,the postoperative LVEDD,LVESD and EF all had improvement compared with the preoperativegenerally.Among the patients without recurrence,the LVESD and EF of patients without taking of preoperative antiarrhythmic drug had improvement compared with the preoperative,and the LVEDD of asymptomatic patients had improvement compared with the preoperative.Meanwhile,the postoperative LVESD and LVEDD were significantly smaller than that before operation in 50%?EF<60% group,and the EF was significantly higher with an early recovery(3 months after operation).In the preoperative EF ? 60% group,the postoperative LVESD and LVEDD were also smaller than that before operation but the improvement was less than 50% ? EF<60% group,while the EF had no significant difference.The preoperative and postoperative difference ? EF,? LVEDD,?LVESDshowed a linear correlation with preoperative EF.CONCLUSION:Frequent PVC can affect the cardiac function.Myocardial remodeling has occurred in the early stage of cardiac function decline.Successful radiofrequency catheter ablation can improve the cardiac function and reverse myocardial remodeling before left ventricular systolic dysfunction induced by PVC.It implies that when cardiac function is still in normal range,early RFCA could also be recommended for patients to reverse myocardial remodeling and prevent PVC induced cardiomyopathy,whether the patient has symptoms or not and whether drug treatment is effective or ineffective.