Left ventricular ejection fraction post ventricular ectopic ablation for PVC related cardiomyopathy- Follow up outcomes

High burden of premature ventricular contraction (PVC) can impair left ventricular ejection fraction (LVEF) and reduction of PVC can improve LVEF to variable degree.

The primary objective is to investigate the predictors of achieving a LVEF ≥ 50% with radiofrequency ablation of PVC and compared with group with LVEF < 50%, post ablation. Secondary, the patterns of medication use pre and post ablation were assessed.

In a retrospective data analysis at a single medical centre, we examined records of 116 patients who had impaired LVEF and underwent successful PVC ablation with reduction of PVC of at least 50% and an improvement of LVEF of ≥ 5%. Demographic, health, medication and procedure related information was collected. Any variables showing significance on univariate analysis were evaluated in a cox proportional hazards regression.

Demographics and procedural details are in table 1. 71 (61%) patients had LVEF ≥ 50% post ablation compared to 45 (39%) whose LVEF improved but remained less than 50%. Patient who had a recovery of the LVEF to ≥ 50% were significantly younger (56 ± 14 yrs vs 66 ± 10 yrs, p<0.001), less likely to have ischemic heart disease (12.7 vs 33.3%, p=0.001), less likely to have scar on the MRI (26.5 % vs 54.1%, p= 0.0176), compared whose LVEF remained <50%. Regarding ablation outcomes, the PVC burden was significantly lower post-ablation (p<0.001) and % reduction of PVC was significantly higher, p<0.001, in patients whose LVEF was≥ 50%.

Cox regression analysis revealed that younger age and higher pre-ablation EF significantly increase the likelihood of EF normalization following ablation (HR = 1.06, p = 0.003), while age showed a slight inverse association (HR = 0.98, p = 0.027). Scar presence was linked to a lower likelihood of normalization (HR = 0.45, p = 0.051). The model demonstrated strong predictive accuracy (concordance = 0.701, p < 0.001), indicating these factors are useful predictors for EF normalization after ablation.

Amongst patients with LVEF improvement to ≥ 50%, assessment during F/U showed that in 75% of patients had LVEF recovered by 1.5 years and others continued to recover over longer F/U.

Medication use is shown in table 1. Patients with recovery of LVEF ≥ 50 % were less likely to be on beta- blocker, ace inhibitor, spironolactone, SGL-2 inhibitors or diuretics compared to patients with LVEF recovery < 50%.

In conclusion, this study found that younger age, higher pre-ablation EF, and lower incidence of cardiac scarring were associated with greater likelihood of EF normalization post-ablation. Improvement in LVEF could continue over long periods. Patients with recovery of LVEF to ≥ 50 % were less likely to be on heart failure medications.Table 1  Figure 1